2015 Survey Report On Household Out of Pocket Expenditure On Health

SURVEY REPORT 2015
Household
Out-of-Pocket Expenditure on Health
Survey Report 2015 OOP Expenditure on Health
Contents
List of Tables II
List of Figures III
List of Acronyms IV
Acknowledgements V
Mauritius at a Glance VI
1. Executive Summary 1
2. Background 8
3. Objectives 15
4. Methodology 16
5. General Findings of the 2015 OOP Survey from Financing Perspective 21

6. Estimates on Household OOP Expenditure on Health FY 2014 (The 32
Integrative Approach)
7. Catastrophic Expenditure on Health 40
8. Conclusion 48
9. Recommendations 50
10. Limitations 53
11. References 54
12. Annexes 55
I
List of Tables
Pages
TABLE I : Private and OOP Health Expenditure 2012, Country Income Groups 10
TABLE II: Expenditure on Health for Mauritius, 2013 10
TABLE III: Legislative Environment and Functions 14
TABLE IV: 2015 Household OOP Survey Team 18
TABLE V: Distribution of Respondents by Gender, OOP Survey 2015 21
TABLE VI: Distribution of Sampled Households By Household Size, OOP 22
Survey 2015
TABLE VII: Distribution of Household Members by Age Group & Gender, OOP 22
Survey 2015, Republic of Mauritius
TABLE VIII: Distribution of Household Members by Age Group and Gender, 23
OOP Survey 2015, Island of Mauritius
TABLE IX: Distribution of Household Members by Age Group and Sex, OOP 23
Survey 2015, Island of Rodrigues
TABLE X: Distribution of Sampled Households by Monthly Income, OOP 24
Survey 2015
TABLE XI: Distribution of Households with Members Suffering from Specific 25
Diseases, OOP Survey 2015
TABLE XII: Health Service Utilization Rate, OOP Survey 2015 27
TABLE XIII: Average Household Monthly Expenditure on Health Items based 28
on Expenditure incurred from January to July 2015, OOP Survey
2015, Republic of Mauritius
TABLE XIV: Average Monthly Expenditure on Health Items by Household Size, 28
OOP Survey 2015, Republic of Mauritius
TABLE XV: Average Monthly Expenditure on Health Items by Household 30
Monthly Income Group, OOP Survey 2015, Republic of Mauritius
TABLE XVI: Estimated Household OOP Expenditure on Health, FY 2014 33
TABLE XVII: Estimated Household OOP Expenditure on Overseas Treatment, 37
FY 2014
TABLE XVIII: Poverty Indicators Based on $ 1.25 a Day Poverty Line 40
TABLE XIX: Poverty Indicators Based on Relative Poverty Line 40
TABLE XX: Financial Sources for Health Payments by Households, OOP Survey 43
2015
TABLE XXI: Percentage of Households Covered by Private Health Insurance, 45
OOP Survey 2015
TABLE XXII: Share of Premium Paid by Households or Company/Employer, OOP 46
Survey 2015
TABLE XXIII: Average Monthly Health Insurance Premium Paid Per Individual, 46
OOP Survey 2015
II
List of Figures
Pages
FIGURE I : Households’ Health Expenditure Map for the Republic of Mauritius 11
FIGURE II : Distribution of Households with Members Suffering from Specific 26
Diseases, OOP Survey 2015, Island of Mauritius and Island of Rodrigues
FIGURE III : Average Monthly Health Expenditure per Household and per Person, 29
FIGURE IV : Average Monthly Health Expenditure per Household and per Person by 30
Household Income Group, OOP Survey 2015, Republic of Mauritius
FIGURE V : Distribution of Estimated OOP Expenditure on Health by Households, 39
Republic of Mauritius, FY 2014
FIGURE VI : Financial Sources for Health Payments by Households, OOP Survey 43
2015, Republic of Mauritius
FIGURE VII : Percentage of Households Experiencing Catastrophic Expenditure on 44
Health in the Island of Mauritius in 2003 and 2015
FIGURE VIII : Graphical Representation of SHA 2011 Financing Framework 51
III
List of Acronyms
CAT - Computer-Assisted Tomography

CIHI - Canadian Institute for Health Information
CT - Computed Tomography
EAs - Enumeration Areas
FY - Financial Year
GDP - Gross Domestic Product
HBS - Household Budget Survey
IHME - Institute for Health Metrics and Evaluation
IHME - Institute for Health Metrics and Evaluation
MFSGIR - Ministry of Financial Services, Good Governance and Institutional
Reforms
MOFED - Ministry of Finance and Economic Development
MOH and QL - Ministry of Health and Quality of Life
MRA - Mauritius Revenue Authority
MRI - Magnetic Resonance Imaging
NGOs - Non-Governmental Organizations
NHA - National Health Accounts
OECD - Organization for Economic Cooperation and Development
OOP - Out-of-Pocket
OTC - Over-the-Counter
PHC - Primary Health Care
PIM - Private Insurance Model
PPP - Purchasing Power Parity
RDI - Relative Development Index
RPL - Relative Poverty Line
RRA - Rodrigues Regional Assembly
SAMU - Service d'Aide Medicale Urgence
SBEH - Subramania Bharati Eye Hospital
SHA - System of Health Accounts
TGE - Total Government Expenditure
UHC - Universal Health Coverage
WHO - World Health Organization
IV
Acknowledgements
Members of the Survey Team wish to extend their gratitude to the Honourable Anil
Kumarsingh Gayan, Minister of Health and Quality of Life for his vision and commitment to
strengthen policy frameworks for health care financing.
Special thanks to Miss H.C.L How Fok Cheung, Senior Chief Executive, Dr. K. Pauvaday,
GOSK, Director General Health Services and Dr. R. K. Domun, Acting Director Health
Services (Planning), for their unflinching support.
The Ministry of Health and Quality of Life acknowledges the:

participation of the public in general and the private health sector, who positively
responded to survey interviews and to primary data requests;
financial support of the World Health Organization and
support of the Chief Commissioners’ Office and the Commission for Sports and
Health of the Rodrigues Regional Assembly.
The Ministry of Health and Quality of Life also acknowledges the contribution of Mr Y.
Ramful, Lead Health Analyst for his invaluable contribution to this project.
All members of the Survey Team, including Mr R. K Bunjun- Deputy Permanent Secretary,
Mr N. Jeeanody – Chief Health Statistician, Mr Y. Thorabally – Statistician (Statistics
Mauritius), Mr G. Rujjoo - Statistical Officer, Mr S. Monohur – Chief Health Records Officer,
Mrs S. Patel – Financial and Governance Analyst, Ministry of Financial Services, Good
Governance and Institutional Reforms, Mr S. Ramphul – Deputy Director Pharmaceutical
Services, Ms K. B. Diop – Intern under Service to Mauritius, Mr E. M. Jummoo - Intern under
Service to Mauritius, Mr K. Bannaroseea – Management Support Officer, Mr Y. Ramoo –
Management Support Officer, Data Entry Officers, Senior Supervisors and all Supervisors
and Interviewers in Mauritius and the island of Rodrigues are gratefully acknowledged for
their respective contribution.
V
Mauritius at a Glance
Map of Mauritius
Source: CSAR
VI
Country Fact Sheet

Geographic location The Republic of Mauritius is located in the Indian Ocean
about 890 km off the east coast of Madagascar
Surface area Land: 2,040 km²
(Mauritius, Rodrigues, Agalega, Cargados Carajos, Chagos
Archipelago and Tromelin)
Total Population (2014) 1,261,447
Capital Port Louis
Population by Port Louis (120,098)
Geographical District Pamplemousses (139,415)
(31 December 2014)* Riviere du Rempart (107,975)
Flacq (138,366)
Grand Port (112,906)
Savanne (68,676)
Plaines Wilhems (368,985)
Moka (83,125)
Black River (80,113)
Island of Rodrigues (41,788)
Land use Agriculture: 43.3%, including sugar cane at 38.6%
(Percentage in 2005)** Built-up areas: 24.9%
Roads: 2.4%
Forests: 25.3%
Others: 4.1%
Climate Maritime subtropical climate with mean temperature of
24.7°C during summer (November to April), and 20.4 °C
during winter (May to October). The topography of
Mauritius makes the central plateau cooler and more
humid than other regions.
Independence 12 March 1968 (from the United Kingdom)
Legal system Based on English common law and French civil law
Political governance Westminster-type parliamentary system of government
Head of State: Her Excellency Dr. (Mrs.) Bibi Ameenah
Firdaus Gurib-Fakim, GCSK, CSK (President)
Head of Government: The Right Honourable Sir Anerood
Jugnauth, GCSK, KCMG, QC, MP, PC (Prime Minister since
December 2014)
General Election: last held on December 11 2014
* Statistics Mauritius, Annual Digest of Statistics, 2014
** Statistics Mauritius, Digest of Agricultural Statistics, 2014
VII
Key Economic and Health Indicators

Indicators 2011 2012 2013 2014 2015*
Total population 1,253,865 1,257,216 1,259,564 1,261,447 1,262,588

Gross Domestic Product (GDP)
323.3 343.9 366.3 386.6 406.6
(Rs billion)
GDP Per Capita 257,843 273,541 290,815 306,473 322,037
Income Per Capita 258,500 274,400 291,300 299,300 316,000
Economic growth rate 3.6 3.4 3.2 3.4 3.4
Inflation rate 6.5 3.9 3.5 3.2 1.3

Unemployment rate 7.8 8.0 8.0 7.8 8.0
Number of live births 14,701 14,494 13,688 13,415 12,738
Number of deaths 9,170 9,343 9,440 9,682 9,747
Population growth rate 0.2 0.3 0.2 0.1 0.1

Life expectancy
73.9 74.1 74.2 74.3 74.5
(Both sexes)
Life expectancy
70.4 70.7 71.0 71.1 71.2
(Male)
Life expectancy
77.5 77.7 77.6 77.7 77.8
(Female)
Infant mortality rate
12.9 13.7 12.1 14.5 13.6
(Per 1,000 live births)
Under five mortality rate
15.9 15.7 14.5 16.0 15.5
Maternal mortality rate
0.34 0.62 0.66 0.52 0.47
Doctor per population
12.4 13.7 16.2 19.3 20.2
(Per 10,000 population)
Nurse per
Population 29.3 29.7 31.5 32.7 33.7
(Per 10,000 population)
*Provisional figures
VIII
1. Executive Summary
1.1 Definition of OOP Expenditure on Health
1.1.1 The World Health Organization (WHO) defines out-of-pocket (OOP) spending on health
as the direct outlays of households, including gratuities made to health practitioners and
suppliers of pharmaceuticals, therapeutic appliances, and other goods and services, whose
primary intent is to contribute to the restoration or to the enhancement of the health
status of individuals or population groups. It also includes non-reimbursable cost sharing,
deductibles, co-payments and fee-for service.
1.2 Objectives of Survey
1.2.1 The main objective of the 2015 Survey was to obtain the most accurate and reliable
data on out-of-pocket spending on health from a nationally representative sample of
households, in the main island of Mauritius and island of Rodrigues, for informing the
second round of National Health Accounts.
1.2.2 The specific objectives of the survey, amongst others, were to determine the extent of
catastrophic expenditure on health among the population and understand the role of
households’ spending on health in a broader macroeconomic context.
1.3 Methodology
1.3.1 In line with the recommendations of the WHO and the Institute for Health Metrics and
Evaluation (IHME), United States of America, the Integrative Approach which is based on
the compilation and analysis of data from three different perspectives, was used to obtain
data on OOP spending on health by households.
1.3.2 These three approaches are, namely, the funding side perspective (outputs of the
survey itself and primary data collection from private stakeholders), the provider side
perspective (other primary and secondary data sources) and the consumption side
perspective from private providers of health services on the consumption of health services
by households.
1.4. Major Findings of the OOP Expenditure on Health Survey 2015
The major findings of the 2015 Survey on Households’ OOP Expenditure on Health, based
on the Integrative Approach are as follows:-
1
1.4.1 Health Service Utilization Rate
1.4.1.1 State-owned health institutions, both hospitals and primary health care facilities,
remain the main providers of health care services to the population.
1.4.1.2 The Survey on Households OOP Expenditure on Health indicates that, in 2015,
approximately 72.8% of the population attended State-Owned health care delivery
institutions for outpatient and inpatient services, while 27.2% of the population sought out
care and treatment from private health care providers.
1.4.2 Household Out-of-Pocket Health Expenditure for FY 2014
1.4.2.1 Households’ OOP expenditures on health in the Republic of Mauritius were

estimated at Rs 10.81 billion in FY 2014, representing an amount of US$ 347.85 million. Out
of this amount, households in the main island of Mauritius spent around Rs 10.71 billion
(US$ 344.82 million), whereas households in Rodrigues paid out approximately Rs 94.14
million or US$ 3.03 million for health services purchased in the private sector.
1.4.2.2 In 2014, total OOP spending on health was around 2.8% of the Gross Domestic
Product (GDP) and per capita OOP spending on health was around Rs 8,568.54 (US$ 275.75)
in the Republic of Mauritius. Per capita OOP expenditure on health was estimated at Rs
8,784.93 (US$ 282.72) in the main island of Mauritius and Rs 2,252.80 (US$ 72.50) in the
island of Rodrigues.
1.4.2.3 Households’ OOP spending on health in the island of Mauritius outsized the budget
of the Ministry of Health and Quality of Life which was Rs 9.21 billion (US$ 296.40 million) in
2014 by almost 16.34%.
1.4.3 Where was most of the money spent by households in 2014?
1.4.3.1 Pharmaceutical products (27.07%), medical supplies and disposables (20.28%),

doctors’ consultation fees (11.20%) and private hospitals (8.58%) accounted for the largest
shares of Mauritian rupees spent on health by households in 2014.
1.4.3.2 In line with the functional classifications of ‘‘A System of Health Accounts 2011’’
produced by the Organization for Economic Cooperation and Development (OECD),
Eurostat and WHO, the rundown of the main categories of health spending by households
in the Republic of Mauritius during the FY 2014 was as follows:-
2
Pharmaceutical Products: An estimated amount of Rs 2.93 billion (US$ 94.15 million)

was spent on these items, out of which, households in the main island of Mauritius,
disbursed approximately Rs 2.90 billion (US$ 93.48 million) and health consumers in
Rodrigues spent some Rs 20.90 million (US$ 0.67 million).
Medical Supplies and Disposables: These items constituted the second-largest

category of total OOP expenditure on health at approximately Rs 2.19 billion
(US$ 70.55 million). A significant percentage of this amount formed part of user fees
claimed by private hospitals.
Medical Consultation Fees: Fees paid to medical practitioners, including specialists,

for the purchase of both outpatient and inpatient services, amounted to
approximately Rs 1.21 billion (US$ 38.96 million). Out of this amount, Rs 3.5 million
(US$ 0.11 million) were spent by patients from Rodrigues who travelled to the main
island of Mauritius to seek treatment in the private sector.
User Fees-Private Hospitals: To avoid double counting, spending on pharmaceutical

products, medical supplies and disposables and consultation fees have been
excluded in the computation of user fees paid to private hospitals. Estimated OOP
spending by households on user fees claimed by private hospitals amounted to Rs
927.20 million (US$ 29.84 million), out of which, patients from Rodrigues travelling
to Mauritius for health care services in the private sector spent some Rs 200,000
(US$ 0.01 million).
Fees for Dentists and Opticians: User fees paid by households for dental care
services amounted to Rs 390.10 million (US$ 12.55 million), whereas fees paid to
opticians were estimated at Rs 456.70 million (US$ 14.70 million).
Glasses and Other Vision Products: These items have a direct health purpose.
Estimated OOP spending by households on glasses and other vision products
amounted to Rs 453.00 million (US$ 14.58 million), out of which, an approximate
amount of Rs 6.0 million (US$ 0.19 million) was spent by households in Rodrigues.
Laboratory Services: An estimated amount of Rs 294.30 million (US$ 9.47 million)

was spent on laboratory services which form an integral part of health care services.
Imaging Diagnostics: Estimated OOP spending by households on imaging diagnostic

services, including plain X-Rays, Computer-Assisted Tomography (CAT) and Magnetic
3
Resonance Imaging (MRI) amounted to some Rs 233.50 million (US$ 7.51 million),
including Rs 2.5 million (US$ 0.08 million) by households in Rodrigues.
Health-Related Transport: Estimated OOP spending on inland transportation of

patients to both the public and private health sectors amounted to Rs 423.00 million
(US$ 13.61 million).
The amount spent by health consumers in the main island of Mauritius on this item
was around Rs 398.00 million (US$ 12.81 million). Health consumers in Rodrigues
spent some Rs 25.00 million (US$ 0.80 million) on this item, including costs of return
air fare tickets for domestic flights.
Overseas treatment: OOP spending on overseas treatment was estimated at Rs

423.50 million (US$ 13.63 million). Out of this amount, Rs 419.00 million (US$ 13.48
million) were spent by patients of the main island of Mauritius and Rs 4.50 million
(US$ 0.14 million) by patients in the island of Rodrigues. Foreign countries visited for
medical care, include amongst others, South Africa, Reunion Island, India and
France.
Fortifying/Restorative Health Products: Estimated OOP spending by households on

these items amounted to Rs 280.10 million (US$ 9.01 million). This amount includes
Rs 1.1 million (US$0.04 million) spent by households in Rodrigues
Reimbursable cost-sharing: Reimbursable cost-sharing applies to households having

private health insurance policies. It is a percentage of the total cost of a health
service which is being paid by the patient and later refunded by the insurer.
OOP payments for this item amounted to Rs 370.20 million (US$ 11.91 million), out of
which, approximately Rs 2.3 million (US$ 0.07 million) were paid by households in
Rodrigues.
Immunization: Estimated OOP spending by households on immunization amounted

to Rs 16.40 million (US$ 0.53 million), including an approximate amount of Rs 1.4
million (US$0.05 million) spent by inhabitants of Rodrigues.
Reproductive Health Services: Around Rs 7.20 million (US$ 0.23 million) were spent
on reproductive health services, out of which Rs 200,000 (US$ 0.01 million) were
spent in the island of Rodrigues.
4
User Fees – NGOs: User fees paid to the NGOs was estimated at Rs 4.90 million
(US$ 0.16 million).
Others: Estimated OOP spending by households on other miscellaneous items such

as services for home-based rehabilitative care, purchase of hearing aids, wheelchairs
and other orthopedic appliances and other expenses related to disability, amounted
to some Rs 177.30 million (US$ 5.71 million). It is also estimated that households
spent some Rs 3.00 million (US$ 0.10 million) on dialysis.
1.4.4 Catastrophic Expenditure on Health: According to the WHO, health expenditure is

viewed as catastrophic whenever it is greater than or equal to 40% of a household’s non-
subsistence income, i.e. income available after basic needs have been met.
1.4.4.1 The Survey on Household OOP Expenditure on Health revealed that 3.6% of
households in the Republic of Mauritius experienced catastrophic expenditure on health in
2015. In the main island of Mauritius, the percentage of households having experienced
catastrophic expenditure on health in 2015 was 3.7% and in Rodrigues it was 1.2%.
1.4.4.2 In the Republic of Mauritius, 3.0% of households had to borrow from banks and other
financial institutions to pay for their health bills in 2015. 8.1% of households borrowed from
friends and relatives and 0.3% of them resorted to the sale of their properties, including
land and buildings to meet health care expenditures in 2015.
1.4.5 Private Health Insurance
1.4.5.1 In 2015, around 15 private health insurance companies were operating in the country
and some 185,000 lives were insured.
1.4.5.2 During FY 2014, the total amount of premiums collected by private insurance
companies through the contributions of individuals and corporates, including employees’
contributions, amounted to approximately Rs 1.51 billion (US$ 48.59 million), compared to
Rs 565.50 million (US$ 18.34 million) in FY 2008/09.
1.4.5.3 Total claims settled by insurers, in 2014, amounted to approximately Rs 1.07 billion
(US$ 34.43 million), out of which, claims settled directly to policyholders amounted to some
Rs 367.90 million (US$ 11.84 million).
5
1.5 Other Findings
1.5.1 The 2015 Survey on Household OOP Expenditure on Health revealed that hypertension
and diabetes, with their related conditions, were at the top of the list of the most
commonly diseases reported in 2015.
1.5.2 In the Republic of Mauritius, 42.2% of the households interviewed reported having at
least one member suffering from hypertension and related diseases, followed by 34.3% of
households with medical conditions of diabetes and related diseases.
1.5.3 In the main island of Mauritius, 42.2% of the households reported having at least one
family member suffering from hypertension and related diseases and 34.8% reported having
members inflicted with diabetes and their related complications.
1.5.4 In Rodrigues, 42.7% of the households reported having at least one member suffering
from hypertension and related diseases, and 19.7% of households reported having members
suffering from diabetes and related conditions.
1.6 Recommendations
1.6.1 The main results of the 2015 Survey on households OOP expenditures on health will be
used to inform the second round of National Health Accounts (NHA) 2015. NHA 2015 will be
developed in line with ‘‘A System of Health Accounts 2011’’ produced by the Organization
for Economic Cooperation and Development (OECD), Eurostat and WHO.
1.6.2 Estimates on household OOP spending on health will be critical inputs for the
development of the NHA 2015 Matrices which will include the following:
MATRIX I: Health Expenditure by Financing Agents and by Financing Schemes

MATRIX II: Health Expenditure by Financing Schemes and by Health Care Providers
MATRIX III: Health Expenditure by Financing Schemes and by Functions of Care
MATRIX IV: Health Expenditure by Health Care Providers and by Functions of Care
1.6.3 The findings of the Survey, which provide evidence-based information on the total
estimated amount of OOP spending by households, set the platform for revisiting the health
care financing mechanisms in the country, if needs arise.
6
1.6.4 One among the objectives of Universal Health Coverage is that there should be
financial-risk protection in place to ensure that the cost of using care does not put people
at risk of financial hardship. The report provides evidence-based information to private
health insurance companies to further promote ‘financial risk protection’ schemes among
people who prefer to seek care and treatment in the private sector.
1.6.5 In order to promote ‘financial risk protection’ schemes, Government may wish to
consider the possibility of increasing the relief on medical insurance premium for tax
payers.
1.6.6 Estimated data on households’ OOP expenditures on health will be used to make
comparisons of the national country’s health system, including the general health status
and health care financing indicators with other countries.
7
2. Background
2.1 Health Care Financing
2.1.1 Financial resources are critical inputs for any national health system to effectively
respond to peoples’ legitimate demands for quality health care services and to improve
health outcomes.
2.1.2 The World Health Organization (WHO) defines health financing as the “function of a
health system concerned with the mobilization, accumulation and allocation of money to
cover the health needs of the people, individually and collectively, in the health system. The
purpose of health financing is to make funding available, as well as to set the right financial
incentives to providers, to ensure that all individuals have access to effective public health and
personal health care”. (WHO 2000)
2.1.3 It is estimated, that in 2013, the world spent US$ 6.6 trillion on health. This amount
represented some 8.7% of global Gross Domestic Product (GDP). Around 57.7% of the
estimated global expenditure on health was incurred by Governments. The share of Out-of-
Pocket (OOP) spending on health in low income countries was nearly 50% of total health
care expenditure in 2013.
2.2 Health Care Financing- The Country Context
2.2.1 The national health care financing system in the Republic of Mauritius is based on a
combined model of financing, a mix of the Beveridge Model, the Private Insurance Model
and the Out-of- Pocket Spending Model.
2.2.2 The Beveridge model of health care financing drives the public health sector. Under
this model, Government, through the Ministry of Finance and Economic Development
(MOFED) in its capacity as financing source, raises revenue through taxes and other means,
to finance the provision of social services, including affordable free health and care services
to all residents of the country.
2.2.3 For the current financial year (FY 2015-2016), the budget allocated to the Ministry of
Health and Quality of Life is Rs 9.72 billion or US$ 267.67 million, representing some 2.39% of
Gross Domestic Product (GDP) and 8.06% of Total Government Expenditure (TGE). Per
capita public expenditure on health is Rs 7,963.75 or US$ 223.33.
8
2.2.4 The Private Insurance Model (PIM) is characterized by individual or employment-

based purchase of private health insurance policies.
2.2.5 Employment-based insurance policies include health insurance schemes covering

employees of a company and are usually financed by the individual and employer
contributions. Private voluntary health insurance schemes are financed by individuals and
usually cover the individual and household members.
2.2.6 Around 15 private health insurance companies were operating in Mauritius in 2015. For
the FY 2014, the turnover of health insurers in respect to premiums paid by individuals,
corporates (including employees’ contributions), amounted to approximately Rs 1.51 billion
(US$ 48.66 million).
2.2.7 Out-of-pocket health care expenditure, where households and individuals pay for
health care out of their own resources, is an important characteristic of health care
financing systems around the globe.
2.2.8 The World Bank defines Out-of-Pocket expenditure on health as follows:
“Out–of-pocket expenditure on health refers to any direct outlay by households, including

gratuities and in-kind payments, to health practitioners and suppliers of pharmaceuticals,
therapeutic appliances, and other goods and services whose primary intent is to contribute to
the restoration or enhancement of the health status of individuals or population groups.”
2.2.9 In many developing countries, household out-of-pocket (OOP) spending on health

constitutes a significant share of total health care expenditure. The WHO estimates, that
globally, private expenditure on health in most countries is approximately 1.5 to 3.0 per
cent of their Gross Domestic Product (GDP). In 2013, it was estimated, that, globally, out-of-
pocket expenditure as a percentage of private expenditure on health, was 51.6%.
2.2.10 In 2012, the World Health Organization estimated that private health expenditure as
a % of total health expenditure was 62.5% for low income countries, and, 44.4% and 38.5% for
upper middle income and high income countries respectively.
2.2.11 TABLE I gives an indication of the level and share of private health expenditure by
country income groups.
9
TABLE I: Private and OOP Health Expenditure 2012, Country Income Groups
Country Group World Private Health Out-of-Pocket Out-of-Pocket
Bank Classification Expenditure as a Health Health
% of Total Health Expenditure as a % Expenditure as a %
Expenditure of Private Health of Total Health
Expenditure Expenditure
Low income 62.5 76.7 47.9
Lower middle income 61.6 86.7 53.4

Upper middle income 44.4 72.5 32.2
High income 38.5 35.8 13.8
All 40.1 44.5 17.8

Source: WHO. 2014. Global Health Expenditure Database
2.2.12 TABLE I above indicates that Out-of-Pocket expenditure on health as a % of private

health expenditure was estimated at 76.7% for low income countries, 72.5% for upper middle
income countries and 35.8% for high income countries. Besides, Out-of-Pocket health
expenditure as a % of total health expenditure for low income countries was estimated at
47.9%, 32.2% for upper middle income countries and 13.8% for high income countries.
TABLE II: Expenditure on Health for Mauritius, 2013

Total Health General Government Private Expenditure Out of Pocket
Expenditure (THE) Expenditure on Health on Health (PEH) Payment
as % of GDP as % of THE as % of THE as % of PEH
4.8 49.1 50.9 91.4
Source: WHO, Global Health Observatory data repository
2.2.13 According to WHO estimates, as illustrated in TABLE II, total health expenditure,
which includes public and private spending, as a percentage of GDP in the Republic of
Mauritius was 4.8% in 2013. Out of total health expenditure, the share of the State was
49.1%, whilst that of private entities, including households, was 50.9%. OOP expenditure on
health as a percentage of total private expenditure on health in the Republic of Mauritius
was estimated at 91.4%.
2.2.14 The first NHA Study undertaken in 2006 indicated that for FY 2001/02, Total Health
Expenditure (THE) for the Republic of Mauritius was Rs 6.12 billion (US$ 211.01 million),
representing 4.5% of GDP. Out of this total amount, the State spent Rs 3.16 billion
(US$ 109.06 million). OOP spending on health by households was estimated at Rs 2.32
10
billion (US$ 79.86 million) in FY2001/02. Households spent Rs 119.3 million (US$ 4.11 million)
on private insurance.
2.2.15 FIGURE I below displays the Households’ Health Expenditure Map for the Republic of
Mauritius, including the island of Rodrigues.
FIGURE I: Households’ Health Expenditure Map for the Republic of Mauritius
Curative care
- Inpatient / Outpatient
- Daycare/Home-based
Preventive care
Rehabilitative care
Information, education
- Inpatient/ Outpatient
and counselling
/Immunization - Daycare /Home-based
programmes etc.
Medical goods
Ancillary services
Pharmaceuticals and
other medical non durable Laboratory/ Imaging
/ Therapeutic appliances - Patient transportation
and other medical durable
2.3 Health Service Delivery System
2.3.1 The national health care delivery network in Mauritius incorporates both not-for profit
and profit making sectors. The not-for profit sector is mainly represented by the State which
intervenes in the national health care market through direct involvement in the funding and
provision of affordable and free health services to all residents.
2.3.2 Other not-for profit stakeholders operating in the country include local government
institutions, not-for profit non-governmental and faith based organizations, civil society
organizations and not-for profit multilateral agencies.
2.3.3 Profit-making stakeholders and other entities in the national health care system
include, amongst others, private hospitals, private medical practitioners and other health
11
care workers, including dentists providing ambulatory services, health insurance

companies, private pharmacies and medical imaging facilities, medical laboratories, non-
allopathic medical practitioners and for-profit non-governmental organizations. Payments
for health care services in the private sector are effected through direct out-of-pocket
payments by users or through voluntary private health insurance.
2.4 Public Health Sector
2.4.1 Mauritius provides free affordable health care services to all its citizens. As the
frontline entry point to the national health system, Primary Health Care (PHC) institutions
act as “gatekeepers” for patients’ access to hospitals.
2.4.2 A comprehensive package of primary care services is provided through a network of

18 Area Health Centres, 116 Community Health Centres , 5 Medi-Clinics, 2 Community
Hospitals and other satellite PHC institutions. General curative and specialized health
services are provided at five Regional Hospitals, two district hospitals and five specialized
hospitals with a total bed capacity of 3,560.
2.4.3 In 2014, 4,468,324 attendances were recorded at the 141 primary health care
institutions for the treatment of common diseases and minor injuries. Around 40% of
patients attending public health institutions were seen by doctors at primary health care
centres. 217,007 attendances were recorded at dental clinics in 2014.
2.4.4 The five regional hospitals admitted 171,751 in-patients in 2014 and the number of
operations performed was 31,745. A total of 2.7 million out-patient cases were attended by
doctors at the Regional and district hospitals. The number of outpatient attendances at
the Subramania Bharati Eye Hospital (SBEH), the Ear/Nose/Throat Centre, the Mental Care
Centre and Poudre d’Or Hospital/ Chest Clinic was 120,273 during the same year. In-patient
admissions to these institutions were 24,088.
2.4.5 In 2014, the Cardiac Centre catered for 22,831 out-patient visits, performed 1,480
surgeries, including neurosurgeries and 2,214 angioplasties and angiographies. For the year
2014, a total number of 247 complicated cases were referred for treatment abroad by
Government.
2.4.6 The main institutions providing support services include the following: Central Health
Laboratory (CHL) and regional laboratories, the Mauritius Blood Service, imaging and
rehabilitative services, the Service d'Aide Medicale Urgence (SAMU), and hotel services.
12
2.4.7 In 2014, the public health sector employed approximately 12,765 of the national health
workforce. There were 2,429 doctors in the country, out of which 1,077, including 300
specialists, were working in the public sector in 2014.
2.4.8 Out of the total number of 366 dentists, 58 were employed by the State. 494
pharmacists were registered in 2014, out of which only 27 were working in the public sector.
2.4.9 Qualified nurses and midwives working in the public sector in 2014 numbered 3,331 out
of the total number of 4,125 employed in the country. Other paramedical personnel in the
public sector included 1,809 Hospital Attendants, 999 Health Care Assistants (General), 206
Medical Laboratory Technicians, 218 Pharmacy Technicians (including Store Manager) and
388 Health Records personnel.
2.5 Private Health Sector
2.5.1 In 2014, 17 private hospitals with some 656 beds were operating in the country.
Besides, there were 20 private medical laboratories and 324 private pharmacies. In addition,
114 NGOs in the island of Mauritius and 16 NGOs in Rodrigues were involved in health and
health related activities.
2.5.2 The private health sector employed around 2,000 employees in 2014. During the same
year, 1,352 doctors, 308 dentists and 467 pharmacists were practising in the private sector.
2.5.3 Private hospitals in the country catered for 227,954 admissions and other attendances
in 2014. In the same year, there were a total number of 3,446 births in private hospitals, out
of which, 1,265 were normal deliveries, 1,950 were caesarean deliveries and 231 were
instrumental deliveries.
2.5.4 The private sector in Rodrigues comprised only two pharmacies and a few Non-
Governmental Organizations (NGOs). A few number of inhabitants travelled to the main
island of Mauritius and other foreign countries to seek care and treatment in the private
sector.
2.5.5 Legislation: TABLE III indicates some of the legislations governing the health sector,
with their respective objectives.
13
TABLE III: Legislative Environment and Functions

Legislation Objective
To regulate practices for the prevention of

morbidity and mortality due to communicable
Public Health Act 1925
diseases and for ensuring an environment free
of health hazards
To provide for the modernization and
The Food Act 1998 consolidation of the law relating to the quality
of food
The Medical Council Act 1999 To regulate the practice of medicine
Dental Council Act 1999 To regulate the practice of dentistry

To regulate and control the nursing and
The Nursing Council Act 2003
midwifery professions
To regulate the manufacture, import and sale
Pharmacy Act 1983
of pharmaceutical products
To provide for the prevention of damage to
The Dangerous Chemicals Control Act 2004 health and to the environment caused by
dangerous chemicals
To regulate the management of mental health
Mental Health Care Act 1988
care services
To organize training of health professionals
Mauritius Institute of Health Act 1989
and to conduct health systems research.
Ayurvedic & Other Traditional Medicine Act To regulate the practice of ayurvedic and
1989 traditional medicine
To promote blood donation and ensure a safe
Mauritius Blood Service Act 2010 and adequate supply of blood and blood
products
To regulate the profession of opticians in
Opticians (Registration Act) 1962
Mauritius
To regulate and license private health
Private Health Institutions Act 1989
institutions
14
3. Objectives
3.1 Main Objective
3.1.1 The main objective of the survey aimed at acquiring accurate and reliable data on out-
of-pocket (OOP) spending on health from a nationally representative sample of
households, in the main island of Mauritius and Rodrigues, to inform the second round of
National Health Accounts 2015.
3.2 Specific Objectives
3.2.1 The specific objectives of the survey, inter-alia, aimed at:-
determining the extent of catastrophic expenditure on health,
understanding the role of household spending on health in a broader

macroeconomic context,
quantifying out-of-pocket spending in accordance with the International

Classification of Health Care Functions (ICHA-HC),
determining the extent and pattern of health care spending in the private sector by
households,
assessing health service utilization rate by households in both the public and private
sectors,
assessing the health profile, including morbidity related to major non-communicable

diseases,
estimating the magnitude of financial risk protection mechanisms among

households seeking care and treatment in the private sector and,
providing reliable data for evidence-based policy making to both the public and
private sectors.
15
4. Methodology
4.1 Integrative Approach
4.1.1 A central activity in developing National Health Accounts (NHA) is the generation and
the use of data collected through surveys. Surveys remain an important source of primary
data for the analytical dimensions of health accounts.
4.1.2 Surveys of a random sample of the universe are familiar ones. In this type of survey, a
certain number of respondents are chosen and the results are used for estimating the
universe surveyed.
4.1.3 In line with the recommendations of the World Health Organization (WHO) and the
Institute for Health Metrics and Evaluation (IHME), United States of America, the
Integrative Approach was used for the 2015 Survey on Household OOP Expenditure on
Health to obtain the most accurate and reliable data on households spending on health in
the Republic of Mauritius, including Rodrigues.
4.1.4 The Integrative Approach combines the following three methodologies with
necessary adjustments,
Financing side perspective: estimations using primary data from financing sources
which include findings of the 2015 National Survey on Households OOP Expenditure
on Health and primary data from private health insurers and the Mauritius Revenue
Authority (MRA)
Provider side perspective: estimations using primary data from providers of health
care services in the private sector through the undertaking of non-stochastic
surveys, and
Consumption side perspective: estimations using data on the consumption of

services e.g. composition of household spending on particular goods or services.
Non-stochastic surveys on private health entities provided the necessary
information.
16
4.2 Financing Perspective - 2015 Survey on Household OOP Expenditure on Health
4.2.1 Survey Coverage: For the purpose of the 2015 Survey on Household out-of-pocket
(OOP) Expenditure on Health, the concept of household is based on arrangements made by
individual persons or in groups for the provision of food and other essentials for living.
4.2.2 The survey covered 3,375 households in the Republic of Mauritius, which included
2,700 households in the island of Mauritius and 675 households in Rodrigues. The coverage
was representative of all regions, both urban and rural, across the two islands. Households’
coverage comprised 12,099 persons with 5,859 or 48.4% male and 6,240 or 51.6% female.
4.2.3 In the main island of Mauritius, surveyed households comprised 9,648 persons, with
4,678 or 48.5% male and 4,970 or 51.5% female. In Rodrigues, surveyed households included
2,450 persons, with 1,180 or 48.2% male and 1,270 or 51.8% female.
4.2.4 Sampling Design: A stratified two stage sampling design, with probability
proportional to size, was adopted to ensure representativeness and a reasonable degree of
precision. At the first stage, 50 Enumeration Areas (EAs) were selected from a total of
3,615. At the second stage, 40 households were selected from each selected EA.
4.2.5 To ensure an even geographical distribution and sufficient representation of all socio-
economic groups of the population, EAs were first classified into strata using geographical
districts and the Relative Development Index (RDI) as criteria. RDI is a composite indicator
developed to categorize EAs according to their socio-economic levels. The number of EAs
selected from the strata was proportional to their sizes, that is, the number of the
population RDI level in each district.
4.2.6 At the second stage, households were randomly selected within each EA. The first
household to be interviewed was chosen by the supervisory staff and the next 39
households were then chosen in a systematic manner to avoid bias.
4.2.7 Survey Data Collection Instrument: The questionnaire was designed using
categorization that would produce general information and the necessary data as per the
requirements of the National Health Accounts (NHA) 2015 Study. The questionnaire, a copy
of which is at ANNEX 12.1, had five main sections, namely,
Section A: Socio-Demographic Profile of the Interviewee

Section B: Household Health Profile
17
Section C: Private Health Insurance

Section D: Health Expenditure (January to July 2015)
Section E: Health Expenditure for July 2015 to determine the extent of catastrophic
expenditure on health.
4.2.8 Survey Team: For the successful and timely implementation of the project, a Survey
Team was constituted and it comprised officers of the Ministry of Health and Quality of Life
(MOH and QL), Statistics Mauritius, the Ministry of Financial Services, Good Governance and
Institutional Reforms (MFSGIR) and the Rodrigues Regional Assembly (RRA). The Team was
responsible to ensure that the survey would meet both the main and specific objectives of
the study. Composition of the Survey Team is indicated in TABLE IV below,
TABLE IV: 2015 Household OOP Survey Team

Manpower Number
Chief Investigator 1
Administrator 1
Investigator 2
Chief Supervisor 1
Senior Supervisor 2
Supervisor 13
Data Analyst 2
Data Manager 1
Data-Entry Clerk 5
Report Writing/Editor 1
Support Staff 2
4.2.9 Field Work: The field work team comprised one Chief Supervisor, 2 Senior Supervisors
(one for North Region and one for South Region in the Island of Mauritius), 13 Supervisors
and 75 Interviewers (including 3 Supervisors and 15 Interviewers for the Island of
Rodrigues).
4.2.10 The Chief Supervisor, the Senior Supervisors and the Supervisors, who were
responsible to the Chief Investigator and the Investigators, were assigned the tasks of
selecting and training the interviewers. The Supervisors and the Senior Supervisors were
also attributed the tasks of monitoring field work and ensuring collection of standard and
quality data. The Chief Supervisor was responsible for the overall management of field
work.
18
4.2.11 Training: Training workshops were organized for all senior supervisors, supervisors,
interviewers and data entry clerks. The main objective of the training was to ensure control
and smooth running of fieldwork in order to collect quality data. During the training,
participants were also trained on the filling of the questionnaires, interview techniques and
their responsibilities towards the interviewees.
4.2.12 Pre-Testing and Data Collection: The questionnaire was pre-tested and all issues
which came across during the pre-testing exercises were addressed to. Data were collected
by face to face interviews of the heads of households. Each Interviewer was responsible for
collecting data from the 40 selected households in the selected EA.
4.2.13 Data Processing: Questionnaires were verified for completeness and accuracy by the
Supervisors. The data were then entered and processed in EXCEL. Tabulation and further
analysis were performed using the statistical package STATA.
4.2.14 Primary data were also collected from the Mauritius Revenue Authority (MRA) and
the private health insurers through the undertaking of non-stochastic surveys. Non-
stochastic surveys generate a fairly large amount of relevant information and provide in-
depth understanding and information with regard to expenditure on health. Questionnaires
sent to these entities are in ANNEX 12.4 and ANNEX 12.5.
4.3 Provider and Consumption Sides Perspectives
4.3.1 On the provider and consumption sides’ methodologies, non-stochastic surveys were
carried out to obtain data from health service providers operating in the private sector.
4.3.2 Specific questionnaires, in line with the functional classifications of the System of
Health Accounts (SHA) 2011, were designed and sent to providers. A desk follow-up was
made to ensure that the questionnaires were being properly filled in by the respondents.
4.3.3 Non-stochastic surveys to obtain data on the provider and consumption sides’
approaches were carried out for private hospitals, private laboratories, NGOs and
Pharmacies in Rodrigues. The following questionnaires, annexed to the Report are as
follows:-
Questionnaire - Private Hospitals: ANNEX 12.2
Questionnaire - Private Laboratories: ANNEX 12.3
Questionnaire - NGOs: ANNEX 12.6
Questionnaire - Pharmacies in Rodrigues : ANNEX 12.7
19
4.3.4 In addition to the non-stochastic surveys, other non-random surveys were carried out
and which included, key informant interviews, focus group discussions and exit direct
interviews.
4.4 Linear Interpolation
4.4.1 Linear interpolation refers to making estimates between two observed points in the
variable of interest using a linear model. In order to calculate the estimates, the aggregate
change in the variable is divided into the corresponding number of equally valued pieces
and those pieces are added sequentially starting with the earlier value of the variable.
4.4.2 With the richness of data collected from the 2015 survey, data for FY 2014 were
derived through the appropriate process of linear interpolation and use of the appropriate
indicator for inflation relating to health items. This process was necessary to inform the
development of NHA 2015 which track actual and audited expenditures incurred during one
financial year.
4.5 Quality Assurance
4.5.1 To ensure quality assurance of the Report on the 2015 Survey on OOP Expenditure on
Health by Households, the draft findings were validated by the National Health Accounts
(NHA) Committee. The NHA Committee comprising representatives of both public and
private institutions has for main responsibilities the following:
Coordination of the process of capturing financial data from different
stakeholders;
Ensuring the timely and successful implementation of the survey on
household OOP expenditure on health;
Development of the NHA matrices and
Validation of final NHA Reports.
20
5. General Findings of the 2015 OOP Survey from the Financing

Perspective
5.1 Households’ Characteristics
5.1.1 Household Coverage: The concept of household is based on arrangements made by

persons, individually or in groups, for the provision of food and other essentials needed for
living. A household may consist of only one person or a group of related or unrelated
persons.
5.1.2 The 2015 Survey on Household out-of-pocket (OOP) Expenditure on Health covered
3,375 households in the Republic of Mauritius, with 2,700 households in the main island of
Mauritius and 675 households in the island of Rodrigues. Out of the total number of
372,000 households in the Republic of Mauritius, 359,350 households resided in the island
of Mauritius and 12,650 in the island of Rodrigues in 2015.
5.1.3 Households surveyed in the Republic of Mauritius comprised 12,099 persons, with
5,859 or 48.4% male and 6,240 or 51.6% female. TABLE V below indicates the distribution of
respondents by gender for the 2015 Survey on Household OOP Expenditure on Health.
TABLE V: Distribution of Respondents by Gender, OOP Survey 2015

Gender Island of Island of Republic of Mauritius
Mauritius Rodrigues
Number Number Number %
Male 4,679 1,180 5,859 48.4
Female 4,970 1,270 6,240 51.6
Total 9,649 2,450 12,099 100.0
5.1.4 The distribution of households by gender, as illustrated in TABLE V above, indicates

that the survey covered 9,649 persons in the main island of Mauritius with 4,679 or 48.5%
male and 4,970 female or 51.5% female. For Rodrigues, the 675 households embraced 2,450
persons, comprising 1,180 male (48.2%) and 1,270 female (51.8%).
5.1.5 Household Size: The size of a household is defined as the number of persons living in
the household. The average size of the households surveyed was 3.6. In the Republic of
21
Mauritius, households of size 4 were most common (25.5%), followed by those of size 3
(22.1%). The distribution of sampled households by household size is indicated in TABLE VI
below.
TABLE VI: Distribution of Sampled Households by Household Size,

OOP Survey 2015
Household Island of Island of Republic of Mauritius
Size Mauritius (%) Rodrigues (%)
(%)
1 8.3 7.9 8.2
2 19.3 18.1 19.1
3 22.0 22.8 22.1
4 25.6 25.0 25.5
5 14.4 15.9 14.7
6 or more 10.4 10.4 10.4
Total 100.0 100.0 100.0
5.1.6 Household Members: TABLE VII below indicates the distribution of household
members classified by age group and gender in the Republic of Mauritius.
TABLE VII: Distribution of Household Members by Age Group & Gender,

Age Group Male Female Total
(Years) (%) (%) (%)
Below 18 26.6 24.5 25.5
18 t0 59 59.3 58.3 58.8
60 and above 14.1 17.2 15.7
Total 100.0 100.0 100.0
5.1.7 As displayed in TABLE VII above, the survey covered around 25.5% children aged less
than eighteen years and 15.7% elderly people, that is, those aged 60 years or more in the
Republic of Mauritius. Analysis by sex shows a higher proportion of elderly among female
(17.2%) than among male (14.1%). Household members aged between 18 years and 59 years
constituted 58.8% of the population surveyed.
22
5.1.8 The distribution of household members classified by age group and sex for the Island
of Mauritius is illustrated in TABLE VIII.
TABLE VIII: Distribution of Household Members by Age Group and Gender,

OOP Survey 2015, Island of Mauritius
Age Group Male Female Total
(Years) (%) (%) (%)
Below 18 23.9 22.1 23.0
18 t0 59 61.1 59.6 60.4
60 and above 14.9 18.2 16.6
Total 100.0 100.0 100.0
5.1.9 TABLE VIII above indicates that, in the island of Mauritius, the survey covered around
23.0% children aged less than eighteen years, 60.4% of household members aged between
18 years and 59 years and 16.6% elderly people, that is, those aged 60 years or more.
Analysis by gender shows that there was a higher proportion of elderly among female
(18.2%) than among male (14.9%).
5.1.10 The distribution of household members for the survey in Rodrigues, classified by age
group and sex is shown in TABLE IX.
TABLE IX: Distribution of Household Members by Age Group and Sex,

OOP Survey 2015, Island of Rodrigues
Age group Male Female Total
(Years) (%) (%) (%)
Below 18 37.2 33.7 35.4
18 to 59 52.0 53.1 52.6
60 and above 10.8 13.1 12.0
Total 100.0 100.0 100.0
5.1.11 TABLE IX above discloses, that in the island of Rodrigues, around 35.4% were children
aged less than 18 years and 12.0% were elderly people, that is, those aged 60 years or more.
Analysis by sex shows a higher proportion of elderly among female (13.1%) than among male
23
(10.8%) were surveyed. Household members aged between 18 years and 59 years
constituted 52.6% of the population surveyed.
5.1.12 Household Income: Households surveyed in the Republic of Mauritius have been
classified into five broad income groups according to their average monthly income.
5.1.13 TABLE X below illustrates the distribution of sampled households by their monthly
income for the Republic of Mauritius, including the main island of Mauritius and the island
of Rodrigues.
TABLE X: Distribution of Sampled Households by Monthly Income,

OOP Survey 2015
Household Monthly Distribution of Households
Income 2015 (%)
(Rs)
Island of Island of Republic of
Mauritius Rodrigues Mauritius
Up to 5,000 3 10 5
5,001 – 10,000 12 27 15
10,001 – 15,000 16 18 16
15,001 – 20,000 17 14 16
20,001 and above 52 31 48
Total 100 100 100
5.1.14 As indicated in TABLE X above, in the Republic of Mauritius, around 15% of households
surveyed had a monthly income ranging from Rs 5,001 to Rs 10,000 and 16% were in the
income group of Rs 10,001 to Rs 15,000. Those drawing a monthly income above Rs 20,000
represented 48%. Low income households, that is, those with up to Rs 5,000 per month,
made up 5% of the total number of households surveyed.
5.2 Health Profile
5.2.1 The 2015 Survey on Household OOP Expenditure on Health gives an indication of the
extent of specific cases of morbidity among households.
5.2.2 TABLE XI indicates the percentage of households who reported having at least one
family member suffering from one or more of the non-communicable diseases in the
24
country. Hypertension and diabetes, with their related conditions, were at the top of the
list of the most commonly reported diseases in 2015.
TABLE XI: Distribution of Households with Members Suffering from Specific Diseases,
OOP Survey 2015
Disease % of Households
Mauritius Rodrigues Mauritius
Hypertension & Related conditions 42.2 42.7 42.2
Diabetes & Related conditions 34.8 19.7 34.3

Eye Disease 18.7 20.9 18.8
Asthma/chronic respiratory disease 13.3 15.3 13.4
Heart Diseases 14.3 8.4 14.1
Mental and Behavioral disorders 5.5 6.7 5.5
Cancer/Tumor 1.8 1.5 1.8
5.2.3 In the main island of Mauritius, 42.2% of the households reported having at least one
family member suffering from hypertension and related diseases. 34.8% of households
reported having members inflicted with diabetes and their related complications.
5.2.4 In the island of Rodrigues, 42.7% of the households reported having at least one
member suffering from hypertension and related diseases, and 19.7% of households
reported having members affected by diabetes and related conditions.
5.2.5 In the Republic of Mauritius, 42.2% of the households interviewed reported having at
least one member suffering from hypertension and related diseases, followed by diabetes
and related conditions with 34.3% of households reporting having members affected by the
disease.
5.2.6 The disease burden among the population in the island of Mauritius and in the island
of Rodrigues disclosed by the 2015 OOP Survey is illustrated in FIGURE II.
25
FIGURE II: Distribution of Households with Members Suffering from Specific Diseases,
OOP Survey 2015, Island of Mauritius and Island of Rodrigues
45 42.2 42.7
Island of Mauritius
40 Island of Rodrigues
34.8
35
30
% Households
25
19.7 20.9
20 18.7
15.3 14.3
15 13.3
10 8.4
5.5 6.7
5 1.8 1.5
0
Hypertension & Diabetes & Eye Disease Asthma/chronic Heart Diseases Mental and Cancer/Tumor
Related Related respiratory Behavioral
conditions conditions disease disorders
5.3 Health Service Utilization Rate
5.3.1 In the Republic of Mauritius, out of all patients seeking care and treatment in 2015,
66.1% of outpatient cases were treated in the public sector and 26.2% in the private sector.
4.3% of inpatient cases were cared for in the public sector while the private sector catered
for 0.8% of inpatient cases. 2.4% of households received day care treatment in the public
sector and 0.2% in the private sector.
5.3.2 Public-owned health institutions, both hospitals and primary health care facilities
remain the main providers of care and treatment to the population. It is estimated that in
2015, 72.8% of patients sought care in the public sector while 27.2% of patients resorted for
care and treatment in the private sector.
5.3.3 TABLE XII indicates the health service utilization rate, in the public and private sector,
classified by the type of treatment such as outpatient, inpatient and day care.
26
TABLE XII: Health Service Utilization Rate, OOP Survey 2015

Type of treatment Island of Island of Republic of
Mauritius (%) Rodrigues (%) Mauritius (%)
Public sector 71.9 98.9 72.8
Outpatient 65.5 82.1 66.1
Inpatient 4.1 9.5 4.3
Day care 2.3 7.3 2.4
Private sector 28.1 1.1 27.2
Outpatient 27.1 1.1 26.2
Inpatient 0.8 0 0.8
Day Care 0.2 0 0.2
Total (Public + Private) 100 100 100
5.4 Health Expenditure in the Republic of Mauritius, 2015
5.4.1 Health expenditure items: Expenditure on health items covers all expenses incurred
directly or indirectly for health purposes. For the 2015 OOP Expenditure Survey, households
in the Republic of Mauritius were requested to report on all amounts spent during the
period January to July 2015 on specific goods and services purchased from the private
sector. TABLE XIII indicates the average monthly expenditure on health per household,
incurred from January to July 2015.
5.4.2 From TABLE XIII, expenditure incurred by a household in the Republic of Mauritius on
pharmaceutical products, averaged at Rs 495 per month, was the most important item of
expenditure. More than a quarter (27.2%) of the total expenditure on health items was on
pharmaceutical products.
5.4.3 Besides expenditure on pharmaceutical products, the main percentage share of the
total health expenditure incurred per month per household during 2015 is as follows:
Fees to private doctors including dentists and opticians – 23.2%

Payment to private clinics – 7.9%
Health insurance premiums – 11.7%
27
TABLE XIII: Average Household Monthly Expenditure on Health Items based on

Expenditure incurred from January to July 2015, OOP Survey 2015, Republic of Mauritius
Expenditure item Average Monthly % of Total Monthly
Expenditure per Expenditure on Health
Household (Rs)
January to July 2015 Year 2015
Pharmaceutical Products 495 27.2
Payment to private clinics 143 7.9
Health insurance premiums 213 11.7
Private doctor’s consultation fee 301 16.5
Purchase of Spectacles and contact
110 6.0
lenses
Fees to dentists and opticians 121 6.7
Purchase of Fortifying/Restorative
67 3.7
Health Products
Health Related transport 106 5.8
Anti-mosquito commodities - -
Overseas treatment 109 6.0
Laboratory test and Screening 109 6.0
Other health related expenses 45 2.5
Total 1,819 100
5.4.4 Health expenditure by household size: TABLE XIV below shows average monthly
expenditure incurred by households of different sizes, in the Republic of Mauritius, as well
as the per capita expenditure, which gives a better indication of how expenditure varies as
household size increases.
TABLE XIV – Average Monthly Expenditure on Health Items by Household Size,

Household Size Average Monthly Expenditure per Average Monthly Expenditure
Household (Rs) per Person (Rs)
1 893 893
2 1,589 794
3 1,822 607
4 1,888 472
5 1,834 367
6 or more 2,781 413
All households 1,819 509
28
5.4.5 From TABLE XIV, it is noted that per capita expenditure on health items decreases
with increasing size of households. In 2015, in the Republic of Mauritius, households with
only one member, comprising mainly elderly persons, spent an average of Rs 893 per
month. The average monthly expenditure for all households worked out to Rs 1,819 per
household while the average monthly expenditure per person for all households is
estimated at Rs 509 per person.
5.4.6 The bar chart below (FIGURE III) illustrates the average monthly expenditure on health
per household and per person of households of different sizes.
FIGURE III: Average Monthly Health Expenditure per Household and per Person,
3000 2,781
2500
2000 1,822 1,888 1,834

1,589
RS
1500
1000 893 893

794
607
472 413
500 367
0
1 2 3 4 5 6 or more
Households
Average monthly expenditure per household (Rs)

Average monthly expenditure per person (Rs)
5.4.7 Health expenditure by household income: The survey data show that average
household expenditure on health items increased with increasing income of the
households.
5.4.8 TABLE XV and FIGURE IV illustrate average monthly expenditure on health per
household in respect to their income and also expenditure per individual, in the Republic of
Mauritius.
29
TABLE XV – Average Monthly Expenditure on Health Items by Household

Monthly Income Group, OOP Survey 2015, Republic of Mauritius
Average Household Average Monthly Average Monthly
Monthly Income (Rs) Expenditure per Expenditure per Person
Household (Rs) (Rs)
Up to 5,000 797 567
5,001 – 10,000 659 270
10,001 – 15,000 786 237
15,001 – 20,000 1,247 338
20,001 and above 2,665 663
All Income Groups 1,819 509
FIGURE IV: Average Monthly Health Expenditure per Household and per Person by Household
Income Group, OOP Survey 2015, Republic of Mauritius
3000
2,665
2500
2000
RS
1500 1,247
1000 797 786

659 663
567
500 270 338
237
0
Up to 5,000 5,001 - 10,000 10,001 - 15,000 15,001 - 20,000 20,001 and above
Income range
Average monthly expenditure per household (Rs)

Average monthly expenditure per person (Rs)
5.4.9 As shown in TABLE XV and FIGURE IV, in 2015, average monthly expenditure on health
incurred by a household in the Republic of Mauritius having an average monthly income of
up to Rs 5,000 was estimated at around Rs 797. That amount rose to approximately Rs
30
2,665 for households with income of more than Rs 20,000 per month. Average monthly
health expenditure per household varied from around Rs 659 to Rs 1,247 for households in
the income bracket ‘5,001 – 10,000 rupees’ per month to households with income ranging
from Rs 15,001 to Rs 20,000 per month. It is noted, however, that average monthly health
expenditure per household among the first three income brackets, ‘Up to 5,000 rupees’,
‘5,001 – 10,000 rupees’ and ‘10,001 – 15,000 rupees’ did not differ much.
5.4.10 In the first category i.e. households drawing income up to Rs 5,000, the average
monthly amount spent per person for health purposes was estimated at Rs 567. The
amount increased from Rs 270 per month in the category ‘5,001 – 10,000 rupees’ to Rs 237
per month in the category ’10,001 – 15,000 rupees’ and to Rs 338 per month in the
category ’15,000 – 20,000 rupees”. In the highest income bracket i.e. ‘20,001 and above
rupees’, the average amount calculated was Rs 663.
31
6. Estimates on Household OOP Expenditure on Health for FY2014

(The Integrative Approach)
6.1 Integrative Approach
6.1.1 Mauritius is one among the few countries in the world and the first country in the
African Region to use the integrative methodology to track down data on households’ Out-
of-Pocket (OOP) expenditure on health. The integrative methodology is recommended by
the World Health Organization (WHO) and the Institute for Health Metrics and Evaluation
(IHME), United States of America to obtain the most reliable estimates on health
expenditures incurred by households.
6.1.2 Data collected from this survey will be primarily used to inform the second round of
National Health Accounts (NHA) 2015. NHA 2015 will be developed in line with the
classifications of ‘‘A System of Health Accounts 2011’’ produced by the Organization for
Economic Cooperation and Development (OECD), Eurostat and WHO which recommends
the tracking down of actual and audited expenditures incurred during one financial year. As
such, with the richness of data collected from the 2015 Survey, data for the FY 2014 were
computed through the appropriate process of linear interpolation and the use of
appropriate indicator for inflation relating to spending on health items.
6.1.3 The estimated expenditures on health items as indicated in TABLE XVI are in line with
the functional classifications of the System of Health Accounts 2011.
6.1.4 ANNEX 12.8 and ANNEX 12.9 display data on household OOP spending on health
collected from the Financing, Provider and Consumption perspectives and computation of
these data to obtain the final integrative estimates.
6.2 Estimated Household OOP Expenditure on Health, Republic of Mauritius, FY 2014
6.2.1 As indicated in TABLE XVI, households’ OOP expenditure on health in the Republic of
Mauritius during FY 2014 was estimated at Rs 10.81 billion, representing US$ 347.85 million.
Out of this amount, households in the main island of Mauritius spent around Rs 10.71 billion
million or US$ 3.03 million.
32
TABLE XVI: Estimated Household OOP Expenditure on Health, FY 2014

INTEGRATIVE OOP EXPENDITURE ON HEALTH, FY 2014
Functional Classifications Island of Island of Republic of
(System of Health Accounts 2011) Mauritius Rodrigues Mauritius
Rs (M) US$ (M) Rs (M) US$(M) Rs (M) US (M)
I Pharmaceutical Products 2,904.60 93.48 20.90 0.67 2,925.50 94.15
II Medical Supplies and Disposables 2,191.60 70.53 0.66 0.02 2,192.26 70.55
III Doctors' Consultation Fees 1,207.00 38.84 3.50 0.11 1,210.50 38.96
IV Dentists' Fees 390.00 12.55 0.10 0.00 390.10 12.55
V Opticians' Fees 456.00 14.68 0.70 0.02 456.70 14.70
VI Laboratory Services 293.00 9.43 1.30 0.04 294.30 9.47
VII Imaging Diagnostics 231.00 7.43 2.50 0.08 233.50 7.51
VIII Users’ Fees - Private Hospitals 927.00 29.83 0.20 0.01 927.20 29.84
IX Users’ Fees - NGOs 4.52 0.15 0.38 0.01 4.90 0.16
X Glasses and other Vision Products 447.00 14.39 6.00 0.19 453.00 14.58
XI Health-Related Transport 398.00 12.81 25.00 0.80 423.00 13.61

XII Overseas Treatment 419.00 13.48 4.50 0.14 423.50 13.63
XIII Treatment of Rodriguan patients in 0.00 0.00 20.10 0.65 20.10 0.65
Mauritius
XIV Fortifying/Restorative Health 279.00 8.98 1.10 0.04 280.10 9.01
Products
XV Reimbursable cost sharing* 367.90 11.84 2.30 0.07 370.20 11.91
XVI Immunization 15.00 0.48 1.40 0.05 16.40 0.53
XVII Family Planning 7.00 0.23 0.20 0.01 7.20 0.23
XVIII Dialysis 3.00 0.10 0.00 0.00 3.00 0.10
XIX Others 174.00 5.60 3.30 0.11 177.30 5.71
TOTAL 10,714.62 344.82 94.14 3.03 10,808.76 347.85
*private health insurance
6.2.2 Households’ OOP spending on health in the island of Mauritius outsized the budget of
the Ministry of Health and Quality of Life which was Rs 9.21 billion (US$ 296.40 million) in
2014 by almost 16.34%. Total OOP spending on health in the Republic of Mauritius was
around 2.8% of the Gross Domestic Product (GDP) in 2014.
6.2.3 In 2014, per capita OOP expenditure on health was estimated at Rs 8,784.93
(US$ 282.72) in the main island of Mauritius and Rs 2,252.80 (US$ 72.50) in the island of
Rodrigues. For the Republic of Mauritius, per capita OOP spending on health was around Rs
8,568.54 (US$ 275.75) in 2014.
33
6.3 OOP Expenditure on Health by Functional Classifications in the Republic of Mauritius
6.3.1 Where was most of the money spent by households in 2014?
6.3.2 Pharmaceutical Products made up the largest component of health care spending by
households, in 2014, accounting for 27.07% of total OOP health expenditure. Medical
supplies and disposables represented the second-largest share (20.28%), while fees paid to
medical practitioners, including specialists made up the third-largest share (11.20%). Fees
paid to private hospitals represented 8.58% of total health spending by households.
6.3.3 Pharmaceutical Products: Pharmaceutical products are used in the diagnosis, cure,
mitigation or treatment of diseases. These products are either retailed to health consumers
in response to a prescription issued by a licensed medical practitioner or traded as non-
prescribed medicines or Over-the-Counter drugs (OTC). Costs of pharmaceutical products
also share out user fees claimed to patients seeking care and treatment in the private
sector.
6.3.3.1 OOP spending on drugs by households in the Republic of Mauritius constituted the
largest category of private health expenditure at Rs 2.93 billion (US$ 94.15 million) in FY
2014, representing 27.07% of total OOP expenditure on health.
6.3.3.2 Households, in the main island of Mauritius, disbursed approximately Rs 2.90 billion
(US$ 93.48 million) on the purchase of pharmaceutical products, whereas, health
consumers in Rodrigues spent some Rs 20.90 million (US$ 0.67 million) in FY 2014. Per
capita spending on pharmaceuticals in the private sector amounted to approximately Rs
2,319.16 (US$ 74.64) in the Republic of Mauritius during FY 2014.
6.3.4 Medical Supplies and Disposables: These items include all medical non-durable goods
purchased either directly by health consumers or included in the bills of patients seeking
services in the private sector.
34
6.3.4.1 Medical supplies and disposables constituted the second-largest category of total
OOP expenditure on health at Rs 2.19 billion (US$ 70.55 million) in FY 2014, representing
20.28% of total spending by households.
6.3.5 Doctors’ Consultation Fees: Fees paid to medical practitioners, including specialists
and surgeons constituted the third-largest category of total OOP health expenditure at Rs
1.21 billion (US$ 38.96 million), representing 11.20% of total private health expenditure in FY
2014,. This amount represented fees paid to doctors/ specialists working exclusively in the
private sector and to State-employed physicians who also undertake private practice after
normal working hours.
6.3.6 Private Hospitals: In 2014, there were 17 private hospitals operating in the country.
Estimated OOP spending by households, in the form of user fees paid to the private
hospitals were to the order of Rs 927.20 million ( US$ 29.84 million) in FY 2014.
6.3.6.1 The abovementioned amount of Rs 927.20 million (US$ 29.84 million) excludes
doctors’ consultation fees and costs of pharmaceutical products, medical supplies and
disposables. The deducted amounts were added to their respective health expenditure
categories. The rationale was to avoid double counting. Besides, amounts paid by
foreigners were also deducted from the total revenue of private hospitals in view of the
fact that the boundary of the survey was limited to OOP spending by residents only.
6.3.7 Dentists’ and Opticians’ Fees: Dental care and vision care are the major discrete
categories of OOP expenditure in the private sector. User fees paid by households for
dental care services amounted to Rs 390.10 million (US$ 12.55 million), whereas fees paid to
opticians were estimated at Rs 456.70 million (US$ 14.70 million) in FY 2014.
6.3.8 Glasses and Other Vision Products: Glasses and other vision products have a direct
health purpose. These items comprise corrective eye-glasses and contact lenses as well as
the corresponding cleansing fluid and the fitting by opticians. Estimated OOP spending by
households on these items amounted to Rs 453.00 million (US$ 14.58 million) in FY 2014.
6.3.9 Laboratory Services: Laboratory services form an integral part of the consumption of
any patient, and constitute a guide for diagnosis and treatment choice. These items
comprise a variety of tests of clinical specimens aimed at obtaining information about the
health of the patient. Estimated OOP spending by households on these items amounted to
Rs 294.30 million (US$ 9.47 million) in FY 2014.
35
6.3.10 Imaging Diagnostics: These items comprise a variety of services that make use of
imaging technology, such as x-rays and radiation for the diagnosis and monitoring of
patients. The SHA classification includes an array of imaging technologies to diagnose and
treat diseases, which, include amongst others, plain x-ray, bone and soft tissue imaging,
contrast x-rays or photo-imaging, diagnostic ultrasound, Computed Tomography (CT),
Computer-assisted Tomography (CAT) and Magnetic resonance imaging (MRI).
6.3.10.1 Estimated OOP spending by households on imaging diagnostic services in the

private sector amounted to some Rs 233.50 million (US$ 7.51 million) in FY 2014.
6.3.11 Users’ Fees, NGOs: A few for-profit non-governmental organizations operate in the
country and charge user fees for the sale of medical goods and services. During FY 2014,
households in Mauritius and in the island of Rodrigues disbursed an approximate amount of
Rs 4.90 million (US$ 0.16 million) to these NGOs.
6.3.12 Health-Related Transport: This item comprises the cost of inland transportation of
patients to a private or public health care facility. Estimated OOP spending by households
on this item in the Republic of Mauritius amounted to Rs 423.00 million (US$ 13.61 million) in
FY 2014.
6.3.12.1 The amount spent by Mauritian on health-related transport was approximately Rs

398.00 million (US$ 12.81 million), while health consumers in Rodrigues spent some Rs 25.00
million (US$ 0.80 million). It is to be noted that the amount spent on health-related
transport by health consumers in Rodrigues relates mostly to the airfare of patients from
Rodrigues travelling to the main island of Mauritius for health care services.
6.3.13 Overseas Treatment: Expenditure on this item includes, cost of clinical treatment,
cost of air ticket, and cost of accommodation, incurred by patients’ relatives travelling to
foreign countries for care and treatment.
6.3.13.1 Estimated OOP spending on health by households to foreign countries amounted to

Rs 423.50 million (US$ 13.63 million) in FY 2014, out of which Rs 419.00 million (US$ 13.48
million) were spent by Mauritians, and Rs 4.50 million (US$ 0.14 million) were spent by
households in Rodrigues.
6.3.13.2 TABLE XVII displays the breakdown of the estimated OOP expenditure by
households on Overseas Treatment for FY 2014.
36
TABLE XVII: Estimated Household OOP Expenditure on Overseas Treatment, FY 2014

ITEMS Mauritius Rodrigues Mauritius
Rs US$ Rs US$ Rs US$

(M) (M) (M) (M) (M) (M)
Cost of Clinical Treatment 259.00 8.34 2.40 0.08 261.40 8.41
Cost of Air Ticket 75.00 2.41 1.40 0.05 76.40 2.46
Cost of Accommodation 85.00 2.74 0.70 0.02 85.70 2.76

Overseas Treatment (excl.
419.00 13.48 4.50 0.14 423.50 13.63
from ROD to MTS)
6.3.13.3 Treatment of Patients from Rodrigues to Mauritius: This item pertains to the cost
incurred by patients from Rodrigues seeking treatment in the main island of Mauritius. It
includes the cost of clinical treatment and the cost of accommodation only, since the
airfare incurred by patients travelling from Rodrigues to Mauritius is regarded as the cost of
inland health-related transport and is already included in item 7.3.9 above.
6.3.13.4 Estimated OOP spending by households in Rodrigues on this item amounted to Rs

20.10 million (US$ 0.65 million) in FY 2014.
6.3.14 Fortifying/Restorative Health Products: Estimated OOP spending by households on

these items amounted to Rs 280.10 million (US$ 9.01 million) in FY 2014.
6.3.15 Reimbursable cost-sharing (Private Health Insurance): According to the definition of

OOP expenditure on health, reimbursable cost-sharing relating to private health insurance
is a form of direct payment for a health service and is therefore considered as an out-of-
pocket payment for health. It is a percentage of the total cost of a health service which is
being paid by the patient and later refunded by the insurer. OOP payments for this item
amounted to Rs 370.20 million (US$ 11.91 million) in FY 2014.
6.3.16 Immunization: This item includes expenditures incurred on the prevention of the
development of a disease, before or after exposure, through the use of pharmaceutical
products such as vaccines. This involves consumption both as a control program and upon
individual demand. Estimated OOP spending by households on this item amounted to Rs
16.40 million (US$ 0.53 million) in FY 2014.
37
6.3.17 Reproductive Health: This item includes expenditure incurred in relation to

reproductive health, including family planning/preventive services, maternity/ reproductive
and routine diagnosis and follow-up of reproductive health that can be part of an initial
medical consultation or check-up, or part of a follow-up inpatient or outpatient contact.
Estimated OOP spending by households on these item amounted to Rs 7.20 million
(US$ 0.23 million) in FY 2014.
6.3.18 Dialysis: A few patients seek dialysis treatment in the private sector. It is estimated
that households spent some Rs 3.00 million (US$ 0.10 million) on dialysis during in FY 2014.
6.3.19 Others: This item includes OOP payments incurred for the following,
home-based rehabilitative care,

purchase of hearing aids,
purchase of wheelchairs and other orthopedic appliances and
other expenses related to disability.
Estimated OOP spending by households on these items amounted to Rs 177.30 million

(US$ 5.71 million) in FY 2014.
6.4 Distribution of Estimated OOP Expenditure on Health by Households
6.4.1 As indicated in FIGURE V, in FY2014, in the Republic of Mauritius, 27.07% of the

estimated total OOP expenditure of Rs 10.81 billion on health was incurred on
pharmaceutical products in the private sector, 20.28% on medical supplies and disposables,
and 11.20% on medical consultation fees.
6.4.2 In FY 2014, the share of user fees effected by households to private hospitals out of
the estimated total OOP expenditure on health was 8.58%, while that effected to NGOs was
0.05%. The shares disbursed to dentists and opticians were 3.61% and 4.23% respectively.
Expenditures effected on glasses and other vision products made up 4.19% of the total OOP.
Share of expenditures on imaging services and laboratory tests out of the estimated total
OOP expenditure on health was 2.16% and 2.72% respectively.
6.4.3 FIGURE V also indicates that in FY 2014, inland health-related transportation

accounted for 3.91% of total OOP expenditure on health, overseas treatment to 3.92%,
treatment of Rodriguans in Mauritius to 0.19% and reimbursable cost-sharing to 3.42% of
total OOP expenditure on health. Spending on fortifying/restorative health products by
households accounted for 2.59% of total OOP expenditure. Moreover, immunization, family
38
planning, dialysis and ‘others’ (i.e. home-based rehabilitative care, hearing aids, wheelchair
& other orthopedic appliances and other expenses related to disability), made up 1.89% of
total household OOP expenditure on health.
Figure V: Distribution of Estimated OOP Expenditure on Health by Households, Republic of

Mauritius, FY 2014
Reimbursable cost
sharing*
3.42% Immunization Family Planning
Fortifying/Restorative
Health Products 0.15% 0.07%
Treatment of Rodriguan 2.59% Dialysis

patients in Mauritius 0.03% Others
0.19% 1.64%
Overseas Treatment
3.92%
Health-Related Transport
3.91%
Glasses and other Vision

Products Pharmaceutical Products
4.19% 27.07%
Users’ Fees - NGOs
0.05%
Users’ Fees - Private

Hospitals
8.58%
Imaging Diagnostics
2.16%
Medical Supplies and
Laboratory Services Disposables
2.72% 20.28%
Opticians' Fees
4.23%
Dentists' Fees
3.61%
Doctors' Consultation
Fees
11.20%
39
7. Catastrophic Expenditure on Health
7.1 Poverty in Mauritius
7.1.1 There is no extreme poverty in Mauritius. The proportion of people living below the
international poverty line of US$ 1.25 (PPP) a day is negligible at less than 1 percent. Based
on US$ 1.25 (PPP) per day, the poverty gap, which measures the depth of poverty, is also
less than 1 percent. (Source: Statistics Mauritius/ Millennium Development Goals Report 2014)
7.1.2 TABLE XVIII below illustrates the poverty indicators based on $ 1.25 a day poverty line
with data from the four Household Budget Surveys (HBS 1996/97, 2001/02, 2006/07 and
2012) undertaken by Statistics Mauritius.
TABLE XVIII: Poverty Indicators Based on $ 1.25 a Day Poverty Line

1996-97 2001-02 2006-07 2012
Proportion of Population Below $ 1.25 (PPP) per

<1 <1 <1 <1
day (%)
<1 <1 <1 <1

Poverty Gap Based on $ 1 .25 (PPP) a day (%)
Source: Statistics Mauritius/MDG Report 2014
7.2 Relative Poverty
7.2.1 Based on Household Budget Surveys (HBS) data, Relative Poverty Line (RPL) is
calculated to assess poverty situation in the country. It is set at half median monthly
household income per adult equivalent. Since 1996/97 to 2012, poverty level in relative
terms has been increasing in terms of both households and persons as indicated in TABLE
XIX below.
TABLE XIX: Poverty Indicators Based on Relative Poverty Line

1996/97 2001/02 2006/07 2012
Relative Poverty Line Half Median
2,004 2,804 3,821 5,652
Monthly Income per Adult Equivalent (Rs)
Proportion of Households in Relative Poverty (%) 8.7 7.7 7.9 9.4
Proportion of Persons in Relative Poverty (%) 8.2 7.8 8.5 9.8

Source: Statistics Mauritius
40
7.3 Universal Health Coverage
7.3.1 According to the World Health Organization, Universal Health Coverage (UHC) is
defined as access to key promotive, preventive, curative and rehabilitative health
interventions with the main objective to achieving equity in access to care and services,
while also ensuring that people do not suffer financial hardship when paying for these
services. UHC embodies three related objectives:
Equity in access to health services - people who need the services should get
them, not only people who can pay for them;
Good quality of health services to improve the health of those receiving
services and
Financial-risk protection to ensure that the cost of using care does not put
people at risk of catastrophic expenditure.
7.4 Catastrophic Expenditure on Health
7.4.1 Out-of-pockets (OOP) financing of health care leave households exposed to the risk of
unforeseen expenditures that absorb a large share of the household budget. Every year,
more than 150 million individuals in 44 million households, across the globe, face financial
catastrophe as a direct result of having to pay for health care.
7.4.2 When people have to pay fees or co-payments for health care, the amount can be so
high in relation to income that it results in “financial catastrophe” for the individual or the
household. Such high expenditure may lead to people cutting down on necessities such as
food and clothing, or are unable to pay for their children's education.
7.4.3 Generally, out-of-pocket (OOP) health payments are viewed as catastrophic when a
household must reduce its basic expenses over a period of time in order to cope with
medical bills of one or more of its members.
7.4.4 The World Health Organization recommends that health expenditure be viewed as
catastrophic whenever it is greater than or equal to 40% of a household’s non-subsistence
income, i.e. income available after basic needs have been met.
41
7.5 Catastrophic Expenditure on Health – Republic of Mauritius
7.5.1 The 2015 Survey on Household OOP Expenditure on Health covered 3,375 households in
the Republic of Mauritius, which included 2,700 households in the island of Mauritius and
675 households in Rodrigues. This corresponds to an average household size of 3.6 persons.
The coverage was representative of all regions, both urban and rural, across the two islands.
Households’ coverage comprised 12,099 persons with 5,859 or 48.4% male and 6,240 or
51.6% female.
7.5.2 In the main island of Mauritius, surveyed households comprised 9,648 persons, with
4,678 or 48.5% male and 4,970 or 51.5% female. In Rodrigues, surveyed households covered
2,450 persons, with 1,180 or 48.2% male and 1,270 or 51.8% female.
7.5.3 Sections E and F of the survey questionnaire aimed at capturing data on catastrophic
expenditure on health in the Republic of Mauritius, including the island of Rodrigues. Data
for this purpose was purposely collected for the month of July 2015 in the island of Mauritius
and that of September 2015 in Rodrigues in order to compute accurate and reliable
estimates on catastrophic expenditure on health.
7.5.4 According to the WHO definition on catastrophic expenditure on health which signifies
that health expenditure be viewed as catastrophic whenever it is greater than or equal to
40% of a household’s non-subsistence income, i.e. income available after basic needs have
been met, the 2015 Survey on Household OOP Expenditure on Health revealed that,
3.6% of households in the Republic of Mauritius experienced catastrophic

expenditure on health, i.e. their health expenditure was greater than or equal
to 40% of their non-subsistence income for the month of July 2015 in the main
island of Mauritius and for the month of September 2015 in Rodrigues.
3.7% of households in the main island of Mauritius experienced catastrophic

expenditure on health i.e. their out-of-pocket health expenditure was greater
than or equal to 40% of a household’s non-subsistence income for the month
of July 2015.
1.2% of households in the island of Rodrigues experienced catastrophic

expenditure on health i.e. their health expenditure was greater than or equal
to 40% of a household’s non-subsistence income for the month of September
2015.
42
7.6 Financial Sources for Health Payments by Households
7.6.1 TABLE XX and FIGURE VI below illustrate the different financial sources of payments
for health services by households in the Republic of Mauritius, including the island of
Rodrigues in 2015.
TABLE XX: Financial Sources for Health Payments by Households, OOP Survey 2015
Financial Sources % No. of Households
Island of Mauritius Island of Rodrigues Republic of

Mauritius
Current Income 95.8 87.3 95.5
Health Insurance 6.7 0.4 6.5

Savings (including Savings
40.6 12.1 39.6
in Banks)
Borrow from Banks/other
3.1 0.4 3.0
Institutions
Borrow from Relatives &
8.4 0.9 8.1
Friends
Sold Assets such as Land,
0.3 0.1 0.3
Buildings, Vehicles, etc.
Other Means 4.9 2.4 4.8
FIGURE VI: Financial Sources for Health Payments by Households, OOP Survey 2015, Republic of
Mauritius
100% 95.5%
90%
80%
70%
60%
50% 39.6%
40%
30%
20%
6.5% 8.1% 4.8%
10% 3.0% 0.3%
0%
Current Health Savings Borrow Borrow Sold Assets Other
Income Insurance (including from from such as Means
Savings in Banks/other Relatives & Land,
Banks) Institutions Friends Buildings,
Vehicles,
etc.
43
7.6.2 As indicated in TABLE XX and FIGURE VI, the Survey on Household OOP Expenditure
on Health revealed that the majority of households in the Republic of Mauritius, i.e. 95.5%
used their current income for effecting health care payments in 2015. During the same year,
39.6% of households had to withdraw from their savings, including savings in banks and
3.0% had to borrow from banks and other financial institutions to pay for their health bills.
7.6.3 The Survey also revealed that in 2015, 8.1% of households in the Republic of Mauritius
had to borrow from friends and relatives in order to effect payments related to the
purchase of health services in the private sector. 0.3% of households resorted to the sale of
their properties, including land, buildings and vehicles to meet health care expenditures in
2015.
7.7 World Health Survey 2003
7.7.1 The World Health Survey (WHS) 2003 reported that 9.0% of households in the Island of
Mauritius experienced catastrophic expenditure on health in 2003. FIGURE VII below
shows the sharp decline of the percentage of households experiencing catastrophic
expenditure on health from year 2003 (WHS 2003) to year 2015 (Household OOP
Expenditure on Health Survey 2015).
FIGURE VII: Percentage of Households Experiencing Catastrophic

Expenditure on Health in the Island of Mauritius in 2003 and 2015
10.0%
8.0%
6.0%
4.0%
2.0%
0.0%
Year 2003 Year 2015
Percentage 9.0% 3.7%
7.7.2 The main reasons attributed to the sharp decline in catastrophic expenditure on health
are the following:
An increase in GDP per capita from Rs 132,687 (US$ 4,647) in 2003 to Rs 321,991
(US$ 9,030) in 2015;
44
Government’s continued efforts to sustain the provision of affordable free health

care services, including a wider range of specialized health care services;
An increase in the number of lives covered by voluntary private health insurance
with 185,000 lives covered in 2015 and
An increase in the allocation of public funds for the treatment of complicated
medical cases abroad which proliferated from Rs 31.0 million (US$ 1.09 million) in
2003 to Rs 58.3 million (US$ 1.88 million) in 2014, representing a percentage increase
of 88%.
7.8 Financial-Risk Protection - Private Health Insurance
7.8.1 Health insurance is defined as a way to distribute the financial risks associated with the
variation of individuals’ health care expenditures by pooling costs over time (pre-payment)
and over people (pooling). Pooling refers to collection and management of revenues in
such a way to ensure that the risk of having to pay for health care is borne by all members
of the pool.
7.8.2 Employment group health insurance includes health insurance schemes covering
employees of a company whereas voluntary private health insurance schemes are financed
by individuals and may cover household members. In 2015, an average of two members per
household was covered by a private health insurance policy.
TABLE XXI: Percentage of Households Covered by Private Health Insurance,

OOP Survey 2015
No. of No. Households Percentage of
Households in Covered by Households Covered by
Sample Survey Health Insurance Health Insurance (%)
Island of Mauritius 2,700 519 19.2
Rodrigues 675 27 4.0
Republic of Mauritius 3,375 546 18.7
7.8.3 As indicated in TABLE XXI above, a low proportion of households surveyed were
covered by private health insurance. In 2015, 18.7% of households in the Republic of
Mauritius reported having members covered by voluntary private health insurance policies.
7.8.4 TABLE XXII displays the share of premium paid by households or company/employer
in 2015. Among those households having members covered by health insurance employer in
45
the Republic of Mauritius, 19% stated that the insurance premiums were being paid by the
company or employer.
7.8.5 Percentage of households who were paying their premiums themselves was
estimated at 33%. For the remaining 48% of households, payments were made by both the
household and the employer.
TABLE XXII: Share of Premium Paid by Households or Company/Employer,

OOP Survey 2015
% N0. of Households
Island of Rodrigues Republic
Mauritius of Mauritius
Household 33 41 33
Company/Employer 19 15 19
Both household and 48 44 48

Company/Employer
Total 100 100 100
7.8.6 TABLE XXIII indicates that average monthly health insurance premium paid per
individual was estimated at Rs 607 in those households in the Republic of Mauritius.
TABLE XXIII: Average Monthly Health Insurance Premium Paid Per Individual,
OOP Survey 2015
Average Monthly Health Insurance Premium Paid per
Individual (Rs)
Island of Mauritius 609
Rodrigues 402
Republic of Mauritius 607
7.8.7 In 2014, some 15 private health insurance companies were operating in the country.
During FY 2014, the total amount of premiums collected by private insurance companies
through the contributions of individuals, corporates, including employees, amounted to
approximately Rs 1.51 billion (US$ 48.66 million), compared to Rs 565.50 million (US$ 18.34
million) in FY 2008/09.
46
7.8.8 Total claims settled by insurers, in 2014, amounted to approximately Rs 1.07 billion
(US$ 34.41 million), out of which, claims settled directly to policyholders amounted to some
Rs 367.90 million (US$ 11.84 million).
47
8. Conclusion
8.1 The World Bank estimates that health care costs will rise by an average of 5.2 percent a
year in 2014-2018, to $9.3 trillion. This increase will be driven by the increasing health needs
of the ageing populations, the rising prevalence of non-communicable diseases and chronic
conditions associated with these diseases, needs to improve health systems, technology
advances and procedural shifts in clinical interventions
8.2 At the Meeting held on 12 June 2015, Cabinet took note of the proposal of the Ministry
of Health and Quality of Life to develop National Health Accounts (NHA) 2015.
8.3 NHA track the flow of all health and health related expenditures, incurred by both
public and private sectors, including households out-of-pocket expenditures, spending by
local authorities and parastatal bodies, employers’ contributions, expenditures by non-
governmental organizations, donors, multilateral and bilateral agencies and other
partners. As an important diagnostic tool, NHA demonstrate the following:-
What is the national health resource envelope?

Where does the money come from?
How are resources mobilized and managed for the health system?
Who pays and how much is paid for health care?
Who provides goods and services? and
How are health care funds distributed across different services, interventions and
activities that the health system provides?
8.4 For the purpose of obtaining data on household OOP expenditure on health, the
Ministry of Health and Quality of Life (MOH and QL) initiated the process to conduct a
random sample survey on out-of-pocket expenditure (OOP) on health incurred by
households in the Republic of Mauritius, including the island of Rodrigues.
8.5 The main objective of the survey was to obtain the most accurate and reliable data on
out-of-pocket (OOP) spending on health from a nationally representative sample of
households, in the main island of Mauritius and Rodrigues in order to inform the second
round of National Health Accounts (NHA) 2015.
8.6 The specific objectives of the survey, amongst others, were to determine the extent of
catastrophic expenditure on health among the population and understand the role of
household spending on health in a broader macroeconomic context.
48
8.7 In line with the recommendation of the WHO and the Institute for Health Metrics and
Evaluation (IHME), United States of America, the Integrative Approach which is based on
the compilation and analysis of data from three different perspectives, was used. These
three approaches are the funding side perspective (outputs of the survey itself and primary
data collection from private stakeholders), the provider side perspective (other primary and
secondary data sources) and the consumption side perspective from private providers of
health services on the consumption of health services by households.
8.8 From the funding perspective, the survey covered 3,375 households in the Republic of
Mauritius with 2,700 households in the main island of Mauritius and 675 households in
Rodrigues. From the provider and consumption sides approaches, non-stochastic surveys
were carried out to obtain primary data from private hospitals, private laboratories, private
imaging centres and insurers.
8.9 Households’ OOP expenditure on health in the Republic of Mauritius was estimated at
Rs 10.81 billion in FY 2014, representing an amount of US$ 347.85 million. Out of this
amount, households in the main island of Mauritius spent around Rs 10.71 billion
million or US$ 3.08 million for health services purchased in the private sector.
8.10 Pharmaceutical products (27.07%), medical supplies and disposables (20.28%), doctors’
consultation fees (11.20%) and private hospitals (8.58%) accounted for the largest shares of
Mauritian rupees spent on health by households in 2014.
8.11 The findings of the Survey will be used to inform the second round of National Health
Accounts (NHA) 2015.
49
9. Recommendations
9.1 Informing the Development of National Health Accounts (NHA) 2015
9.1.1 NHAs are defined as a set of standardized matrices that describe total expenditure
flows on health and health related activities within the health sector, both government and
the private sector, including households’ out-of-pocket expenditures, employers’
contributions, inputs of non-governmental organizations, contributions from donors,
multilateral and bilateral agencies and other partners.
9.1.2 The main results of the 2015 Survey on households OOP expenditures on health will be
used to inform the second round of National Health Accounts (NHA) 2015. NHA 2015 will be
developed in line with ‘‘A System of Health Accounts 2011’’ produced by the Organization
for Economic Cooperation and Development (OECD), Eurostat and WHO.
9.1.3 The International Classifications for Health Accounts (ICHA) schemes of the ‘‘System
of Health Accounts 2011’’, with their respective ICHA codes will be extensively used for the
development of NHA 2015. The NHA dimensions will include the Financing Schemes, the
Health Care Providers, the Financing Agents and the Functions of Care.
9.1.4 Besides, the estimates on household OOP spending on health will be critical inputs for
the development of the NHA 2015 Matrices, which will include the following:
MATRIX I: Health Expenditure by Financing Agents and by Financing Schemes

MATRIX II: Health Expenditure by Financing Schemes and by Health Care Providers
MATRIX III: Health Expenditure by Financing Schemes and by Functions of Care
MATRIX IV: Health Expenditure by Health Care Providers and by Functions of Care
9.1.5 A graphical representation of SHA 2011 financing framework is displayed in FIGURE VIII.
50
FIGURE VIII: Graphical Representation of SHA 2011 Financing Framework
Source: OECD, Eurostat and WHO for SHA 2011.
9.2 Evidence-Based Information for Policy Decisions
9.2.1 The findings of the Survey, which provide evidence-based information on the total
estimated amount of OOP spending by households, set the platform for revisiting the
health care financing mechanisms in the country, if needs arise.
9.3 Catastrophic Expenditure on Health
9.3.1 Universal Health Coverage (UHC) ensures that people do not suffer financial hardship
when paying for health services. One among the objectives of UHC is that there should be
financial-risk protection in place to ensure that the cost of using care does not put people
at risk of financial hardship.
9.3.2 The report provides evidence-based information to private health insurance

companies to further promote ‘financial risk protection’ schemes among people who
prefer to seek care and treatment in the private sector.
51
9.4 Fiscal Measures
9.4.1 In order to promote ‘financial risk protection’ schemes, Government may wish to
consider the possibility of increasing the relief on medical insurance premium for tax
payers.
9.5 International Comparisons
9.5.1 Estimated data on households’ OOP expenditures on health will be used to make
comparisons of the national country’s health system, including the general health status
and health care financing indicators with other countries.
52
10. Limitations
10.1 Household Out-of-Pocket (OOP) expenditures on health are among the most difficult
data to collect and compile in the context of National Health Accounts (NHA). The incorrect
measurement of household OOP expenditures on health can undermine the credibility of
total health spending estimates and NHA data which are important tools for policymaking.
Yet the collection and compilation of OOP expenditures on health are important because
households’ spending on health are typically the first or second largest source of health
care financing in many countries.
10.2 In line with the recommendations of the World Health Organization (WHO) and the
Institute for Health Metrics and Evaluation (IHME), United States of America, the
Integrative Approach was used for the 2015 Survey to obtain the most accurate and reliable
data on OOP spending on health by households in the Republic of Mauritius, including
Rodrigues. The Integrative Approach combines the following three methodologies with
necessary adjustments,
Financing side perspective: estimations using primary data from financing sources,
Provider side perspective: estimations using data from providers of health care
services in the private sector,
Consumption side perspective: estimations using data, in line with the System of
Health Accounts (SHA) 2011 functional classification, obtained from private
providers of health services on the consumption of services by households.
10.3 Paragraph 1.40 of Chapter 1 of the “Guide to producing national health accounts, with
special applications for low-income and middle-income countries” mentions the following: “It
is never possible to estimate health expenditures perfectly and without error. All countries,
no matter how sophisticated their systems, combine “hard” financial figures with “soft”
estimates and extrapolations of hard-to-measure items. Health accounting is both an art
and a science. The team should be prepared for some uncertainties, and should focus their
attention on the big items, without becoming bogged down in small items of inaccuracy”.
10.4 The above limitations do not detract the reliance and usefulness of the findings of the
2015 Survey Report on Household OOP Expenditure on Health.
53
11. References
OECD, Eurostat and WHO (2011), A System of Health Accounts.
Guide to producing national health accounts: with special applications for low-
income and middle-income countries. Geneva: World Health Organization, 2003.
The World Health Report 2000: Health Systems: Improving Performance. Geneva:
World Health Organization, 2000.
World Health Survey, 2003, Geneva: World Health Organization.
EQUITAP Project: Working Paper #5 Explaining the incidence of catastrophic

expenditures on health care: Comparative evidence from Asia.
Rannan-Eliya R. 2007. National Health Accounts Estimation Methods: Household

Out-of-pocket Spending in Private Expenditure. Monograph prepared for
WHO/NHA Unit, Geneva, Switzerland.
National Health Accounts Estimation Methods: Household Out-of-Pocket

Spending in Private Expenditure, DR Ravi P. Rannan-Eliya, Institute for Health
Policy/Asia-Pacific NHA Network, 2008
Tracking Household Health Expenditures in Developing Countries through Major

Population-Based Surveys, USAID 2009.
National Health Accounts Financial Year 2001/02, Ministry of Health and Quality of
Life, Republic of Mauritius, January 2006.
Health Statistics Report 2014, Ministry of Health and Quality of Life.
WHO PAYS? Out-of-Pocket Health Spending and Equity Implications in the Middle
East and North Africa, November 2010, World Bank.
Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJL. Household

catastrophic health expenditure: a multi-country analysis. Lancet 2003; 362: 111-7.
54
12. Annexes
12.1 Questionnaire - Survey on Household Out-of-Pocket Expenditure on Health 2015
REPUBLIC OF MAURITIUS
MINISTRY OF HEALTH & QUALITY OF LIFE
SURVEY ON HOUSEHOLD OUT-OF-POCKET EXPENDITURE ON HEALTH 2015
HOUSEHOLD IDENTIFICATION: Serial No
Locality No: Enumeration Area:
Block No Building Household No
INTERVIEW:
Date of interview: Signature of Interviewer:
Time start : Time end:
Date checked & verified by Supervisor: Signature:
RE-INTERVIEW:
Face-to-face By phone
Signature:
Name:
Date:
55
SECTION A: HOUSEHOLD PROFILE
A1: Household Size (all members of household sharing meals together including the Respondent)
Age Male Female TOTAL
Below 18
18 to 59
60 and above
HOUSEHOLD SIZE
A2: How many members of your household earn salary, pension, alimony, rent or any other income?
SECTION B: HOUSEHOLD HEALTH PROFILE
B1: Has any member of your household ever been diagnosed with any of the following diseases?
State number of
SN Disease
members
(put 0 if none)
a. Diabetes & related conditions
b. Hypertension & related conditions
c. Heart diseases
d. Asthma /Chronic Respiratory disease
e. Cancer/Tumour
f. Eye disease
g. Mental and Behavioural disorders
Others (specify)
I. ……………………………………………………………………
h.
II. ……………………………………………………………………
III. …………………………………………………………………..
56
B2: Has any member of your household suffered from any injury in the period January to July 2015?
1. Yes, admitted
2. Yes, not admitted
3. No
B3: Is there any member of your household in need of constant care due to old age, chronic diseases, disability,
mental problem, injury, or any other problems?
1. Yes
2. No
B4: Is any member of your household taking any medicine regularly?
1. Yes
2. No
B5: In the period January to July 2015, how many times yourself and other members of your household were admitted
or seen by a doctor as follows:
Service Public Sector Private Sector

(January to July 2015) (January to July 2015)
Outpatient Care 1
(No. of attendances)
Inpatient Care 2
(No. of admissions)
Day Care 3
(No. of times)
1
Medical services delivered to a patient who is not admitted and does not stay overnight
2
Admission into a facility for a day or more
3
Patient is admitted and discharged on the same day
57
B6: For the period January to July 2015, have you or any member of your household travelled abroad for medical
treatment? (including from Rodrigues to Mauritius)
1. Yes
2. No (IF “NO”, GO TO B7)
a. If yes, what was the total amount of expenses (excluding government support) incurred:
Rs
b. How much did you spend on the following:

Overseas Treatment Expenses Rs
Medical treatment including admission and other clinical
and non-clinical services
Airfare for patient and accompanying relative(s)
Accommodation and other expenses for accompanying
relative(s)
B7: Has your household incurred any significant non-regular health expenses from January to July 2015?
1. Yes
2. No
If yes, what was this significant amount? Rs
B8: For the period January to December 2014, what were your household estimated health expenses?
Rs
B9: For the period January to December 2014, has your household incurred any significant non-regular health expenses?
1. Yes
2. No
If yes, what was this significant amount spent in 2014? Rs
B10: On average, every month, what amount of money does your household disburse for the purchase of medicines,
including medicines purchased over-the-counter?
Rs
58
SECTION C: HEALTH INSURANCE
C1: How many persons in your household are covered by a health insurance?
(IF NONE, WRITE “0” AND GO TO SECTION D)
C2: Is the health insurance premium paid by the household or any company/employer?
(a) Household
(b) Company/Employer
(c) Both household and company/employer
C3: How much per month does your household contribute in terms of health insurance premium?
Rs
C4: In the period January to July 2015, what amount was refunded to your household by the health insurance company?
Rs
SECTION D: HEALTH EXPENDITURE
D1: How much expenses you or any other member of your household have incurred on the below listed items during
January to July 2015:
SN Item January to July 2015

Expenses (Rs)
1. Outpatient Care
1.1 Consultation fees paid to General Medical Practitioners
1.2 Consultation fees paid to Specialists
1.3 Consultation fees paid to traditional medicine practitioners, including

ayurvedic practitioners
1.4 Consultation fees paid to other health practitioners (Psychologist,
Acupuncturist, etc., excluding dentists and opticians)
2. Inpatient Care
2.1 Total amount paid to Private Clinics

of which:
2.1.1 Consultation fees for doctors/specialists ( )
2.1.2 Drugs ( )
59
2.1.3 Laboratory Tests ( )
2.1.4 Imaging (X-Rays, CT Scan ,MRI, Echography) ( )
2.1.5 Room facilities/Meals ( )
2.1.6 Others ( )
SN Item January to July 2015

Expenses (Rs)
3. Medicines (drugs, traditional medicines, ayurveda, Chinese, etc.)
3.1 Prescribed drugs
3.2 Over the counter
4. Dental Care
4.1 Fees to dentist
4.2 Dental appliances
5. Rehabilitative Care (including physiotherapy)
5.1 Inpatient Rehabilitative Care
5.2 Outpatient Rehabilitative Care
5.3 Home-based Rehabilitative Care
6. Optician fees
7. Spectacles/contact lenses
8. Hearing aids
9. Screening/Check-up fees - outpatient
10. Lab tests (urine, blood) - outpatient
11. Imaging (X-ray, Scan, MRI, Echo) - outpatient
12. Vaccinations (baby & other)
12.1 For babies
12.2 Others ( including for travelling purposes)
13. Family Planning contraceptive methods
14. Dialysis related costs
15. Transport (only for health)
16. Wheelchair & other orthopedic appliances
17. Other expenses related to disability
60
18. Ampoules/‘fortifiants’
19. Other medical non-durable (syringes, bandage, disinfectant, etc.)
SECTION E: Household Total Expenditure
E1: Details of household expenses in July 2015:
SN Item Amount (Rs)
1. Consultation fees:
(doctors/dentists/opticians/other health professionals)
2. Purchase of medicines
3. Other health expenses (excluding insurance premium) 1
4. Health insurance premium
5. Food stuff (rice, meat, fish, pulses, vegetables, fruits, etc)
6. Transport (including education, excluding health)
7. Rent (residential purpose only)
8. Education (fees, tuitions, stationery, books)
9. Leisure/sports/newspaper
10. Alcohol
11. Cigarettes
12. Utilities (CEB, CWA, Telephone) , excluding Internet
13. Loan reimbursement (including hire purchase)
14. Pocket money
15. Mobile phone/tablet
16. Internet/Private TV
17. Premiums for life insurance policies
18. Others 2 (specify)
I. ……………………………………………………………………
II. ……………………………………………………………………
III. ……………………………………………………………………
TOTAL (by interviewer)
1
Health Expenses such as lab tests/x-ray/imaging etc.
2
To exclude capital expenditure such as purchase of land, car, as well as construction of building, holidays abroad.
61
SECTION F: FINANCIAL SOURCES USED BY HOUSEHOLDS FOR EFFECTING PAYMENT RELATED TO HEALTH
F1: In the period January to July 2015, which of the following financial sources did your household use to pay for any
health expenditure? (Read out and Circle 1 or 2 as appropriate)
SN Source 1. Yes 2. No
1. Current income 1 2
2. Health insurance 1 2
3. Savings (including in bank) 1 2
4. Borrow from banks/other institutions 1 2

5. Borrow from relatives & friends 1 2
Sold assets such as land, building,
6. vehicles, personal belongings, household 1 2
commodities etc.
7. Other means (specify) 1 2
F2: What was the Household Total Revenue, including salary, pension, alimony, rent or any other income in the month
of July 2015? (REMIND INTERVIEWEE ABOUT CONFIDENTIALITY OF ALL INFORMATION)
(Insert exact amount after probing. The amount must include revenues of all members of the household in July 2015. Check
for pensions of persons aged 60 years and above in the household)
Rs (Check Total Expenditure in July 2015)
THANK YOU
MY SUPERVISOR MAY RECONTACT YOU FOR ANY CLARIFICATION
YOUR CONTACT DETAILS PLEASE: NAME:
MOBILE NUMBER:
HOME PHONE:
OFFICE PHONE:
62
12.2 Questionnaire - Private Hospitals
MINISTRY OF HEALTH AND QUALITY OF LIFE

NATIONAL HEALTH ACCOUNTS 2015
QUESTIONNAIRE: PRIVATE HOSPITALS
SECTION A: NOTE
1. At the Meeting held on 12 June 2015, Cabinet took note of the proposal of the Ministry of Health and Quality of
Life to develop National Health Accounts (NHA) 2015.
2. NHA track the flow of all health and health related expenditures, incurred by both public and private sectors,
including households out-of-pocket expenditures, spending by local authorities and parastatal bodies, employers’
contributions, expenditures by non-governmental organizations, donors, multilateral and bilateral agencies and other
partners. As an important diagnostic tool, NHA demonstrate the following:-
• What is the national health resource envelope?

• Where does the money come from?
• How are resources mobilized and managed for the health system?
• Who pays and how much is paid for health care?
• Who provides goods and services? and
• How are health care funds distributed across different services, interventions and activities that the health
system provides?
3. Rationale behind NHA: These accounts, inter-alia, provide evidence-based information to policy-makers and other
partners, including the private sector, for stimulating policy decisions. Weaknesses as well as opportunities within
the national health delivery system are revealed and the potentials for identifying possibilities for enhanced
performance are explored and increased.
4. NHA 2015 are being developed in line with the International Classification of Health Accounts (ICHAs) produced by
the World Bank, the World Health Organization and the United States Agency for International Development
st
(USAID). NHA 2015 are being developed on actual expenditures incurred during FY 2014, starting from 1 January to
31st December 2014.
5. Please send filled in questionnaire through email address yramful@govmu.org or n.budaloo@govmu.org or by fax
on Fax Number 208-9814 (Attn. Lead Health Analyst) or by post by latest 01 October, 2015 to Ministry of Health and
th
Quality of Life, Health Economics Unit, 7 Level, Emmanuel Anquetil Building, Port-Louis.
ALL INFORMATION PROVIDED WILL BE TREATED WITH STRICT CONFIDENTIALITY AND WILL BE EXCLUSIVELY USED
FOR DEVELOPING NHA 2015.
63
SECTION B: PROFILE
B.1 Name of Private Hospital :
B.2 Name of Respondent:
B.3 Position of Respondent:
B.4 Address:
B.5 Email Address:
B.6 Telephone Number: Office Mobile
B.7 Date information provided:
st st
B.8 Reporting Period: FY 2014 (1 January -31 December 2014)
SECTION C: ATTENDANCES/ ADMISSIONS/ EXPENDITURE BY PATIENTS
C.1 Indicate the total amount of revenue raised by your institution through the sale of services to patients during FY 2014 (1st January -31st
December 2014).
Rs………………………………………………
C.2 In TABLE I below, indicate the number of attendances/ admissions and the corresponding amount paid by patients for the different services
provided.
TABLE I
Service Mauritian Citizens Foreigners
Attendances/ Amount Paid by Attendances/ Amount Paid by

Admissions Patients Admissions Patients
(RS) (RS)
Outpatient Care
Inpatient Care
Day Care
Total
64
C.3 In respect to replies to C.1 and C.2, indicate the amount paid by patients for each and every health and health-related activities as mentioned
in TABLE II below:
TABLE II
Amount spent by Amount spent by Foreigners

Health and Health-Related Services Mauritian Citizens (RS)
(RS)
C.2.1 Inpatient curative care
C.2.2 Day cases of curative care
C.2.3 Outpatient curative care
C.2.4 Outpatient dental care
C.2.5 All other specialized medical services
C.2.6 All other outpatient curative care
C.2.7 Services of rehabilitative care
C.2.8 Laboratory tests
C.2.9 Diagnostic Imaging (Xrays, CT Scan, MRI, Echography, etc)
C.2.10 Patient transport and emergency rescue
C.2.11 Renal Dialysis
C.2.12 Blood Transfusion
C.2.13 Other miscellaneous ancillary services
C.2.14 Pharmaceuticals
C.2.15 Orthopaedic appliances and other prosthetics
C.2.16 Medico-technical devices, including wheelchairs
C.2.17 Prevention of Communicable diseases
C.2.18 Prevention of Non- Communicable diseases
C.2.19 Health Promotion
C.2.20 Immunization
C.2.20.1 For Babies
C.2.20.2 Others ( including for travelling purposes)
65
C.2.21 Occupational Health Services
C.2.22 All other miscellaneous public health services
C.2.23 Other services
Total
(NOTE: The total amount specified in TABLE I should be the same amount as indicated to reply of C.1.)
SECTION D: MODE OF PAYMENT
D.1 With respect to reply to C.1, please indicate in TABLE III the following:
TABLE III
Mode of payment Mauritian Citizens Foreigners
Rs Rs
(i) Amount paid directly by patients through out-of-pocket

payment (cash, cheques, credit cards etc.)
(ii) Amount paid by health insurance companies
(iii) Amount paid directly by employers in favor of their

employees
Total
(NOTE: The total amount specified in TABLE III should be the same amount as indicated to replies of C.1 to C.3).
66
SECTION E: CAPITAL INVESTMENT
E.1 Indicate the total amount invested for capital development, including construction or upgrading of infrastructure and acquisition of new
equipment during FY 2014.
Capital Investment (FY 2014) Rs
1.
2.
3.
4.
5.
Total
SECTION F: ADMINISTRATIVE & OTHER OPERATING COSTS
F.1 Indicate the total amount spent by your institution on administration and management services out of total revenue collected and as
mentioned in reply C.1 during FY 2014.
Rs………………………………………………
F.2 Indicate the total amount paid by your institution to repay back loans (Capital & Interests) out of total revenue collected and as
mentioned in reply C.1 during the Reporting Period (1st January -31st December 2014).
Rs………………………………………………….
F.3 Please indicate any other additional information you think necessary for the current NHA exercise:
For any other information or clarification, please contact the Lead Health Analyst, Mr Y. Ramful on telephone number 201-2087 or mobile
52532131 or Health Analyst Mrs N. Budaloo on telephone number 201-1721
Thank you for your usual support and collaboration.
Date: 10 September, 2015
67
12.3 Questionnaire – Private Laboratories

QUESTIONNAIRE: PRIVATE LABORATORIES
SECTION A: NOTE
1. At the Meeting held on 12 June 2015, Cabinet took note of the proposal of the Ministry of Health and Quality of Life to
develop National Health Accounts (NHA) 2015.
2. NHA track the flow of all health and health related expenditures, incurred by both public and private sectors, including
households out-of-pocket expenditures, spending by local authorities and parastatal bodies, employers’ contributions,
expenditures by non-governmental organizations, donors, multilateral and bilateral agencies and other partners. As an
important diagnostic tool, NHA demonstrate the following:-

• How are health care funds distributed across different services, interventions and activities that the health system
provides?
partners, including the private sector, for stimulating policy decisions. Weaknesses as well as opportunities within the
national health delivery system are revealed and the potentials for identifying possibilities for enhanced performance are
explored and increased.
4. NHA 2015 are being developed in line with the International Classification of Health Accounts (ICHAs) produced by the
World Bank, the World Health Organization and the United States Agency for International Development (USAID). NHA
st
2015 are being developed on actual expenditures incurred during FY 2014, starting from 1 January to 31st December
2014.
5. Please send filled in questionnaire through email address yramful@govmu.org or n.budaloo@govmu.org or by fax on Fax
Number 208-9814 (Attn. Lead Health Analyst) or by post by latest 15 September, 2015 to Ministry of Health and Quality of
th
Life, Health Economics Unit, 7 Level, Emmanuel Anquetil Building, Port-Louis.
ALL INFORMATION PROVIDED WILL BE TREATED WITH STRICT CONFIDENTIALITY AND WILL BE EXCLUSIVELY USED FOR
DEVELOPING NHA 2015.
68
SECTION B: PROFILE OF PRIVATE HEALTH INSTITUTION
B.1 Name of Private Health Institution:
B.4 Address:
B.5 Email Address:
st st
SECTION C: SPECIFIC INFORMATION (FY 2014).
C.1 Indicate the total amount of revenue raised by your institution through the sale of laboratory investigation services to
st st
health consumers during FY 2014 (1 January -31 December 2014)
Rs………………………………………………
C.2 In TABLE I below, indicate the amount paid to your institution by the corresponding mode of payment provided. (Total
amount should correspond to sum indicated in C.1).
TABLE I
Mode of payment Rs
(i) Amount paid directly by health consumers through out-of-pocket

payment(cash, cheques, credit cards etc)
(ii) Amount paid by health insurance companies
(iii) Amount paid directly by employers in favour of their employees
Total
69
SECTION D: CAPITAL INVESTMENT
D.1 Indicate in TABLE II the total amount invested for capital development, including building or upgrading of
infrastructure and acquisition of new equipment during FY 2014:
TABLE II
Capital Investment (FY 2014) Rs
1.
2.
3.
4.
5.
Total
D.2 Indicate the total amount spent by your institution on administration and management services out of total revenue
collected and as mentioned in reply C.1 during FY 2014.
Rs………………………………………………
D.3 Please indicate any other additional information you think necessary for the current NHA exercise:
For any other information or clarification, please contact the Lead Health Analyst, Mr Y. Ramful on telephone number
201-2087 or mobile 52532131 or Health Analyst Mrs N. Budaloo on telephone number 201-1721
Date: 28 August, 2015
70
12.4 Questionnaire - MRA/Customs- Imports of Drugs, Medical Supplies and Equipment

QUESTIONNAIRE: MRA/CUSTOMS- IMPORTS OF DRUGS, MEDICAL SUPPLIES AND EQUIPMENT
SECTION A: NOTE

provides?
World Bank, the World Health Organization and the United States Agency for International Development (USAID). NHA 2015
st
are being developed on actual expenditures incurred during FY 2014, starting from 1 January to 31st December 2014.
5. Please send filled in questionnaire through email address yramful@govmu.org copied to n.budaloo@govmu.org or by fax
on Fax Number 208-9814 (Attn. Lead Health Analyst) or by post by latest 09 October, 2015 to Ministry of Health and Quality
th
of Life, Health Economics Unit, 7 Level, Emmanuel Anquetil Building, Port-Louis.
71
SECTION B: PROFILE
B.1 Name of Institution/Department :
B.4 Address:
B.5 Email Address:
st st
SECTION C: IMPORTS OF DRUGS AND MEDICAL PRODUCTS
C.1 Indicate the total value of imports to Mauritius in terms on Drugs, Medical Supplies and Medical Equipment during FY
st st
2014 (1 January -31 December 2014).
Rs………………………………………………
C.2 In TABLE I below, indicate the value of imports for the corresponding items
SN Imports Amount (Rs)
1. The total value of drugs imported to Mauritius.
2. Out of this total value of drugs imported, how much was for
Ayurvedic drugs?
3. The total value of medical supplies and disposables (bandages,
syringes, etc) imported to Mauritius.
4. The total value of medical equipment imported to Mauritius.
TABLE I
72
C.3 In respect to reply to C.2, out of the total value of imports, indicate the amount of exports to Rodrigues for each item.
SN Exports Amount (Rs)
1. The total value of drugs exported to Rodrigues.
2. Out of this total value of drugs exported, how much was for
Ayurvedic drugs?
syringes, etc) exported to Rodrigues.
4. The total value of medical equipment exported to

Rodrigues.
C.4 Please indicate any other additional information you think necessary for the current NHA exercise:
201-2087 or mobile 52532131 or Health Analyst Mrs N. Budaloo on telephone number 201-1721
73
12.5 Questionnaire - Health Insurance Companies

QUESTIONNAIRE: HEALTH INSURANCE COMPANIES
SECTION A: NOTE

provides?
st
5. Please send filled in questionnaire through email address yramful@govmu.org or kdiop@govmu.org or by fax on Fax
Number 208-9814 (Attn. Lead Health Analyst) or by post by latest 15 October, 2015 to Ministry of Health and Quality of
th
Life, Health Economics Unit, 7 Level, Emmanuel Anquetil Building, Port-Louis.
74
SECTION B: INSURERS’ PROFILE
B.1 Name of Insurance Company or Provident Fund:
B.2 Type of insurance company: (State-owned/Para-statal/ Private)
B.5 Address:
B.6 Email Address:
st st
B.9 Reporting Period: FY 2014 ( 1 January – 31 December 2014 )
SECTION C: SUBSCRIPTIONS/REVENUE
C.1. In TABLE I below, please indicate the number of subscribers (for health insurance only) to your organization at the end of
the Reporting Period. If health insurance is included as a part of other insurance, please include those subscribers in your
figures.
TABLE I: NUMBER OF SUBSCRIBERS FOR HEALTH INSURANCE ONLY
Group/Company Individual/Family
Number of policies
Number of lives covered
75
SECTION D: PREMIUM COLLECTED
st st
D.1. In TABLE II below, indicate the total amount of premium invoiced clients for the period 1 January -31 December 2014.
TABLE II
Type of Revenue Amount(in Rupees)
Total Group/Company Individual/Family

(General Public)
Employers’ Employees’
contribution Contribution
Premium
(health business only)
Less: Premium discounts

and rebates (health
business only)
Grants from employers:
-Cash
Others (specify)
Total (health business

only)
Reporting basis (circle one): Accrual

Cash
76
D.2. In TABLE III below, indicate your organization’s total expenditures for the Reporting Period.
TABLE III
Amount(in Rupees)
Type of Expense
Total In respect of In respect of
Group/Company Individual/Family
covers covers
1.Claims Paid directly to:
1.1 Private clinics
1.2 Private laboratories
1.3 Pharmacies
1.4 Private Medical Practitioners
1.5 Medical Supplies
1.6 Private Imaging/Diagnostic
Centres
2. Reimbursement made directly
to policy holders, out of
which,
2.1 Consultation fees
2.2 Medicine purchased
2.3 Laboratory Tests
2.4 X Rays, CT Scan, MRI,
Echography
2.5 Private Clinics
2.6 Dental Care & Appliances
2.7 Optical appliances
2.8 Hearing Aids etc)
2.9 Wheelchairs/Orthopedics
Appliances
2.10 Others
3. Total Benefits
4. Additions to reserves
(health business only)
5. Administrative expenses
(health business)
6. Surplus or retained earnings

(health business)
Reporting basis (circle one): Accrual
Cash
77
D.3. Do the revenue figures above include the health portion of premiums for combined life/health policies. (circle one)
Not Applicable
Yes
No
If yes, please enter total benefits paid under such combined policies in the reporting year.
Life Health
D.4. Please indicate any other additional information you think necessary for the current NHA project:
201-2087 or mobile: 5253-2131 or Ms K. Diop on telephone number 201-1721.
Thank you for usual support and collaboration.
Date: 01 October 2015
78
12.6 Questionnaire – Non-Governmental Organisations

QUESTIONNAIRE: NON-GOVERNMENTAL ORGANISATIONS
SECTION A: NOTE

provides?
st
5. Please send filled in questionnaire through email addresses nbudaloo@govmu.org or kdiop@govmu.org, or by fax on Fax
Number 208-9814 (Attn. Lead Health Analyst) or by post by latest 3 December, 2015 to Ministry of Health and Quality of
Life, Health Economics Unit, 7th Level, Emmanuel Anquetil Building, Port-Louis.
79
SECTION B: PROFILE OF NON- GOVERNMENT ORGANIZATION
B.1 Name of Non-Governmental Organization:
B.4 Address:
B.5 Email Address:
B.6 Telephone Number:
Office:
Mobile:
B.7 Indicate the various types of health and health-related activities your organization undertakes.
st st
SECTION C: FINANCING SOURCES.
C.1.Indicate the Total Amount of Funds raised by your Organization during the Reporting Period.
Rs………………………………………………
80
C.2 In respect to C.1, indicate in TABLE I the Financing Sources, that is, where did the funds come from?
TABLE I
Financing Sources Amount Received (Rs)
C.2.1 Ministry of Health & Quality of Life

…………………………………………………….
C.2.2 Other Ministries ( Pl. specify)
(i)……………………………………………………………………………………….. ……………………………………………………..
(ii)………………………………………………………………………………………. ……………………………………………………..
(iii)……………………………………………………………………………………… ……………………………………………………..
C.2.3 Local Authorities (Municipalities/District Councils)
…………………………………………………….
C.2.4 Foreign Agencies/Donors (Exp. UNAIDS, UNFPA, UNDP, WHO
etc.)and other multilateral agencies
(i)………………………………………………………………………………………. …………………………………………………….....
(ii)……………………………………………………………………………………… ………………………………………………………..
(iii)…………………………………………………………………………………….. ………………………………………………………..
(iv) ……………………………………………………………………………………. ………………………………………………………..
(v)……………………………………………………………………………………… ………………………………………………………..
C.2.5 Private Sector (commercial banks, firms, and other business

organizations, etc.)
(i)………………………………………………………………………………………. ……………………………………………………...
(ii)……………………………………………………………………………………… ………………………………………………………
C.2.6 International NGOs

(i)……………………………………………………………………………………… ……………………………………………………….
(ii)…………………………………………………………………………………….. ……………………………………………………….
(iii)…………………………………………………………………………………….. ………………………………………………………
C.2.7 Sale of Goods and Services
………………………………………………………
C.2.8 Self -Raising
……………………………………………………..
C.2.9 Other Financing Sources (incl. accrued interests)
(i)………………………………………………………………………………………. ……………………………………………………...
(ii)……………………………………………………………………………………… ………………………………………………………
(iii)…………………………………………………………………………………….. ………………………………………………………
C.2.10 Total
………………………………………………………
NOTE: The total in C.2.10 should be the same as total of C.1.
81
SECTION D: FUNCTIONS
(Functions are described as the types of goods and services provided and activities performed within the health accounts
boundary. Functions lead to the identification of transactions which take place within the health accounts boundary and also
indicate which health transactions contribute to the various specific aggregate health expenditures.)
D.1 In respect to replies to C.1 and C.2.10, give details of expenditures incurred on each and every health and health related
activity as mentioned below:
Health and Health-Related Activities Amount spent (Rs)
D.1 Outpatient care
D.2 Day cases of curative care
D.3 Services of rehabilitative care
D.4 Rehabilitative home care
D.5 Training for staff
D.6 Environmental Health
D.7 Capital formation (construction of infrastructure, acquisition of equipment etc)
D.8 Laboratory tests
D.9 Diagnostic imaging (Xrays, CT Scan, MRI, Echography, etc)
D.10 Glasses and other vision products
D.11 Orthopaedic appliances and other prosthetics
D.12 Hearing aids
D.13 All other medico-technical devices, incl. wheel chairs
D.14 School health services
D.15 Prevention of communicable diseases
D.16 Prevention of non-communicable diseases
82
D.17 Occupational health services
D.18 All other miscellaneous public health services
D.19 Programme management which include, salaries and operational costs to

manage/supervise the health and health related activities undertaken by your
organization)
D.20 Health Promotion
D.21 Others
Total (should be same as C.1)
NOTE: Please skip services not under the responsibility of your institution.
SECTION E: OTHER INFORMATION
E.1 Please indicate any other additional information you think necessary for the current NHA exercise:
Date: 25 November, 2015
83
12.7 Questionnaire - Pharmacies (Rodrigues)

QUESTIONNAIRE: PHARMACIES (RODRIGUES)
SECTION A: NOTE

provides?
st
5. Please send filled in questionnaire through email address yramful@govmu.org copied to n.budaloo@govmu.org or by fax
on Fax Number 208-9814 (Attn. Lead Health Analyst) or by post by latest 09 October, 2015 to Ministry of Health and Quality
th
of Life, Health Economics Unit, 7 Level, Emmanuel Anquetil Building, Port-Louis.
84
SECTION B: PROFILE OF PHARMACY
B.1 Name of Pharmacy :
B.4 Address:
B.5 Email Address:
B.6 Telephone Number: Office: Mobile:
st st
SECTION C: PURCHASE OF DRUGS AND MEDICAL PRODUCTS
st
C.1 Indicate the total value of purchases in terms on Drugs, Medical Supplies and Medical Equipment during FY 2014 (1
st
January -31 December 2014) of your pharmacy.
Rs………………………………………………
C.2 In TABLE 1 below, indicate the value of items purchased by your pharmacy.
TABLE 1
SN Purchases Amount (Rs)
1. The total value of drugs purchased by your pharmacy.
2. Out of this total value of drugs purchased, how much was for
Ayurvedic drugs?

syringes, etc) purchased by your pharmacy.
4. The total value of medical equipment purchased by your
pharmacy.
85
C.3 In TABLE 2 below, indicate the value of items sold by your pharmacy.
TABLE 2
SN Sales Amount (Rs)
1. The total value of drugs sold by your pharmacy.
2. Out of this total value of drugs sold, how much was for
Ayurvedic drugs?

syringes, etc) sold by your pharmacy.
4. The total value of medical equipment sold by your pharmacy.
C.4 Please indicate any other additional information you think necessary for the current NHA exercise:
For any other information or clarification, please contact the Lead Health Analyst, Mr Y. Ramful on telephone number 201-
2087 or mobile 52532131 or Health Analyst Mrs N. Budaloo on telephone number 201-1721
86
12.8 Expenditure Table, Republic of Mauritius (Rs million)
Island of Mauritius Rodrigues Integrative Approach

Funding perspective Funding perspective
Republic
Household Other Provider Integrative Household Other Provider Integrative Island of
Rodrigues of
OOP Primary perspective Approach OOP Primary perspective Approach Mauritius
Mauritius
Survey Data Survey Data
I Pharmaceutical Products 1,975.00 2,904.60 - 2,904.60 20.90 17.40 - 20.90 2,904.60 20.90 2,925.50
II Medical Supplies and Disposables 45.00 2,191.60 - 2,191.60 0.40 0.66 - 0.66 2,191.60 0.66 2,192.26
III Doctors' Consultation Fees 1,207.00 - 965.00 1,207.00 3.50 - - 3.50 1,207.00 3.50 1,210.50
IV Dentists' Fees 390.00 - 309.00 390.00 0.10 - - 0.10 390.00 0.10 390.10
V Opticians' Fees 99.00 - 456.00 456.00 0.70 - - 0.70 456.00 0.70 456.70
VI Laboratory Services 204.00 - 293.00 293.00 1.30 - - 1.30 293.00 1.30 294.30
VII Imaging Diagnostics 231.00 - - 231.00 2.50 - - 2.50 231.00 2.50 233.50
VIII Users’ Fees - Private Hospitals 556.00 - 927.00 927.00 0.20 - - 0.20 927.00 0.20 927.20
IX Users’ Fees - NGOs - - 4.52 4.52 - - 0.38 0.38 4.52 0.38 4.90
X Glasses and other Vision Products 447.00 - - 447.00 6.00 - - 6.00 447.00 6.00 453.00
XI Health-Related Transport 398.00 - - 398.00 25.00 - - 25.00 398.00 25.00 423.00
XII Overseas Treatment 419.00 - - 419.00 4.50 - - 4.50 419.00 4.50 423.50
Treatment of Rodriguan patients in
XIII - - - 0.00 20.10 - - 20.10 - 20.10 20.10
Mauritius
Fortifying/Restorative Health
XIV 279.00 - - 279.00 1.10 - - 1.10 279.00 1.10 280.10
Products
XV Reimbursable cost sharing 72.60 367.90 - 367.90 2.30 - - 2.30 367.90 2.30 370.20
XVI Immunization 15.00 - - 15.00 1.40 - - 1.40 15.00 1.40 16.40
XVII Family Planning 7.00 - - 7.00 0.20 - - 0.20 7.00 0.20 7.20
XVIII Dialysis 3.00 - - 3.00 - - - - 3.00 - 3.00
XIX Others 174.00 - - 174.00 3.30 - - 3.30 174.00 3.30 177.30
TOTAL 6,521.60 - - 10,714.62 93.50 - - 94.14 10,714.62 94.14 10,808.76
87
12.9 Expenditure Table, Republic of Mauritius (US$ million)
Island of Mauritius Rodrigues INTEGRATIVE APPROACH

Funding perspective Funding perspective
Republic
Household Other Provider Integrative Household Other Provider Integrative Island of
Rodrigues of
OOP Primary perspective Approach OOP Primary perspective Approach Mauritius
Mauritius
Survey Data Survey Data
I Pharmaceutical Products 63.56 93.48 - 93.48 0.67 0.56 - 0.67 93.48 0.67 94.15
II Medical Supplies and Disposables 1.45 70.53 - 70.53 0.01 0.02 - 0.02 70.53 0.02 70.55
III Doctors' Consultation Fees 38.84 - 31.06 38.84 0.11 - 0.11 38.84 0.11 38.96
IV Dentists' Fees 12.55 - 9.94 12.55 - - - 12.55 - 12.55
V Opticians' Fees 3.19 - 14.68 14.68 0.02 - 0.02 14.68 0.02 14.70
VI Laboratory Services 6.57 - 9.43 9.43 0.04 - 0.04 9.43 0.04 9.47
VII Imaging Diagnostics 7.43 - - 7.43 0.08 - 0.08 7.43 0.08 7.51
VIII Users’ Fees - Private Hospitals 17.89 - 29.83 29.83 0.01 - 0.01 29.83 0.01 29.84
IX Users’ Fees - NGOs - - 0.15 0.15 - 0.01 0.01 0.15 0.01 0.16
X Glasses and other Vision Products 14.39 - - 14.39 0.19 - 0.19 14.39 0.19 14.58
XI Health-Related Transport 12.81 - - 12.81 0.80 - 0.80 12.81 0.80 13.61
XII Overseas Treatment 13.48 - - 13.48 0.14 - 0.14 13.48 0.14 13.63
Treatment of Rodriguan patients in
XIII - - - - 0.65 - 0.65 - 0.65 0.65
Mauritius
Fortifying/Restorative Health
XIV 8.98 - - 8.98 0.04 - 0.04 8.98 0.04 9.01
Products
XV Reimbursable cost sharing 2.34 11.84 11.84 11.84 0.07 - 0.07 11.84 0.07 11.91
XVI Immunization 0.48 - - 0.48 0.05 - 0.05 0.48 0.05 0.53
XVII Family Planning 0.23 - - 0.23 0.01 - 0.01 0.23 0.01 0.23
XVIII Dialysis 0.10 - - 0.10 - - - 0.10 - 0.10
XIX Others 5.60 - - 5.60 0.11 - 0.11 5.60 0.11 5.71
TOTAL 209.88 - - 344.82 3.01 - - 3.03 344.82 3.03 347.85
88

2015 Survey Report On Household Out of Pocket Expenditure On Health

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SURVEY REPORT 2015

List of Figures III

5. General Findings of the 2015 OOP Survey from Financing Perspective 21

CAT - Computer-Assisted Tomography

The Ministry of Health and Quality of Life acknowledges the:

Country Fact Sheet

Key Economic and Health Indicators

Total population 1,253,865 1,257,216 1,259,564 1,261,447 1,262,588

Income Per Capita 258,500 274,400 291,300 299,300 316,000

Economic growth rate 3.6 3.4 3.2 3.4 3.4

Inflation rate 6.5 3.9 3.5 3.2 1.3

Population growth rate 0.2 0.3 0.2 0.1 0.1

1.2 Objectives of Survey

1.4. Major Findings of the OOP Expenditure on Health Survey 2015

1.4.1 Health Service Utilization Rate

1.4.2 Household Out-of-Pocket Health Expenditure for FY 2014

1.4.2.1 Households’ OOP expenditures on health in the Republic of Mauritius were

1.4.3 Where was most of the money spent by households in 2014?

1.4.3.1 Pharmaceutical products (27.07%), medical supplies and disposables (20.28%),

Pharmaceutical Products: An estimated amount of Rs 2.93 billion (US$ 94.15 million)

Medical Supplies and Disposables: These items constituted the second-largest

Medical Consultation Fees: Fees paid to medical practitioners, including specialists,

User Fees-Private Hospitals: To avoid double counting, spending on pharmaceutical

Laboratory Services: An estimated amount of Rs 294.30 million (US$ 9.47 million)

Imaging Diagnostics: Estimated OOP spending by households on imaging diagnostic

Health-Related Transport: Estimated OOP spending on inland transportation of

Overseas treatment: OOP spending on overseas treatment was estimated at Rs

Fortifying/Restorative Health Products: Estimated OOP spending by households on

Reimbursable cost-sharing: Reimbursable cost-sharing applies to households having

Immunization: Estimated OOP spending by households on immunization amounted

Others: Estimated OOP spending by households on other miscellaneous items such

1.4.4 Catastrophic Expenditure on Health: According to the WHO, health expenditure is

1.4.5 Private Health Insurance

1.5 Other Findings

MATRIX I: Health Expenditure by Financing Agents and by Financing Schemes

2.1 Health Care Financing

2.2 Health Care Financing- The Country Context

2.2.4 The Private Insurance Model (PIM) is characterized by individual or employment-

2.2.5 Employment-based insurance policies include health insurance schemes covering

2.2.8 The World Bank defines Out-of-Pocket expenditure on health as follows:

“Out–of-pocket expenditure on health refers to any direct outlay by households, including

2.2.9 In many developing countries, household out-of-pocket (OOP) spending on health

Lower middle income 61.6 86.7 53.4

High income 38.5 35.8 13.8

All 40.1 44.5 17.8

2.2.12 TABLE I above indicates that Out-of-Pocket expenditure on health as a % of private

TABLE II: Expenditure on Health for Mauritius, 2013

FIGURE I: Households’ Health Expenditure Map for the Republic of Mauritius

2.3 Health Service Delivery System

care workers, including dentists providing ambulatory services, health insurance

2.4 Public Health Sector

2.4.2 A comprehensive package of primary care services is provided through a network of

2.5 Private Health Sector

TABLE III: Legislative Environment and Functions

To regulate practices for the prevention of

Dental Council Act 1999 To regulate the practice of dentistry

3.1 Main Objective

3.2 Specific Objectives

3.2.1 The specific objectives of the survey, inter-alia, aimed at:-

determining the extent of catastrophic expenditure on health,

understanding the role of household spending on health in a broader

quantifying out-of-pocket spending in accordance with the International

assessing the health profile, including morbidity related to major non-communicable